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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Specialty Services · IN · PM&R (Physical Medicine & Rehab), Psychiatry, Physical Therapy +1 moreHigh impact

BT2025169: IHCP and DDARS announce changes to waiver services, effective Jan. 1, 2026

Effective date
Jan 1, 2026
Identified
Jun 18, 2026

Summary

Indiana Medicaid is sunsetting several waiver services on Dec. 31, 2025 and adding new behavioral support services and self-directed care options starting Jan. 1, 2026. This includes replacing Basic Behavior Management with a new three-component Behavioral Support Services model and introducing self-directed service options across multiple waivers.

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What to do

Action · 6 steps
01By Dec.
0231, 2025: Billing team must stop using sunset procedure codes H0004 U7 U5 U2, H2020 U7 U5 U1, H2020 U7 U5 U2, and consumer-directed S5125 codes.
03By Jan.
041, 2026: Update billing system with new Behavioral Support Services codes (H0004 with UA, UB, UC modifiers) and all new self-directed service codes with proper time limits and budgeted rates.
05Update encounter forms to reflect quarterly authorization for behavioral services instead of annual.
06Train staff on new modifier combinations and service limitations.

Codes mentioned

H0004H2020S5125S5130S5150S5151T1005T1016T1020T2025T2033T2040

Original notice

BT2025169: IHCP and DDARS announce changes to waiver services, effective Jan. 1, 2026
in.gov · Always check the source before changing claims.
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Related changes

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Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesPM&R (Physical Medicine & Rehab)PsychiatryPhysical TherapyOccupational TherapyCode H0004Code H2020Code S5125Code S5130Code S5150Code S5151Code T1005Code T1016Code T1020Code T2025Code T2033Code T2040

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