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Indiana Medicaid (IHCP)Medicaid · Coverage · Provider Bulletin · IN · Physical Therapy, Pulmonology, PM&R (Physical Medicine & Rehab)Medium impact

BT2026169: IHCP to allow reimbursement of PTA-rendered G0238

Act
by Nov 13, 2026
Effective date
Nov 13, 2026
Identified
Oct 14, 2026

Summary

Effective November 13, 2026, Indiana Health Coverage Programs (IHCP) will allow Physical Therapist Assistants (PTAs) to perform and bill HCPCS code G0238 (therapeutic procedures to improve respiratory function) under supervising practitioner supervision. PTA-rendered services must be billed with the supervising practitioner's NPI, modifier HM appended, and will be reimbursed at 75% of the IHCP fee schedule. This change applies to both managed care and fee-for-service medical benefits.

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What to do

by Nov 13, 2026 · 6 steps
01Billing team must implement the following changes for Indiana IHCP claims.
02Update billing system to recognize G0238 as a PTA-billable procedure code when modifier HM is appended.
03Ensure G0238 claims submitted by PTAs include the supervising practitioner's NPI (not the PTA's NPI) and modifier HM appended to the code.
04Configure billing software to apply the 75% fee schedule rate for PTA-rendered G0238 services.
05Verify that prior authorization requirements continue to apply and remain enforced.
06Direct billing questions for fee-for-service claims to Gainwell Technologies at 800-457-4584 and questions for managed care claims to the applicable MCO.
If missed: Failure to append modifier HM or use the supervising practitioner's NPI will result in incorrect billing and potential claim denials.

Codes mentioned

G0238

Original notice

BT2026169: IHCP to allow reimbursement of PTA-rendered G0238
in.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesPhysical TherapyPulmonologyPM&R (Physical Medicine & Rehab)Code G0238

Summaries are AI-assisted. Always confirm against the original payer notice.

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