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BT2026176: IHCP announces updates and corrections to physical and occupational therapy codes
Indiana Medicaid (IHCP)·IN · Physical Therapy, Occupational Therapy·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Oct 23, 2026
Summary
IHCP is requiring modifier GP or GO on prior authorization requests and claims for CPT code 97150 (group therapy) effective December 1, 2026, retroactive to January 1, 2025, to distinguish between physical therapy (GP) and occupational therapy (GO) services. Additionally, CPT code 97542 is being added to the modifier-match requirement table (effective August 19, 2024), and CPT code 92610 is being removed from the table.
Action Required
By April 22, 2027 (180 days from October 22, 2026 publication date): Billing team must submit prior authorization revision requests for CPT 97150 with the appropriate modifier (GP for physical therapy or GO for occupational therapy) to Acentra Health for any services billed between January 1, 2025 and December 1, 2026 that experienced billing issues related to overlapping PT/OT codes. Include a copy of this bulletin (BT2026176, first page only) with PA revision requests and claim resubmissions to obtain approval beyond the 180-day filing limit. After PA approval, resubmit affected claims to Gainwell Technologies for proper processing. All PA submissions and claim resubmissions may be retroactively backdated to January 1, 2025. Additionally, verify that billing system templates now reflect the modifier requirement for CPT 97542 (retroactive to August 19, 2024) and that CPT 92610 has been removed from the modifier-match requirement table. Claims submitted on or after December 1, 2026 without the appropriate modifier will deny with EOB code 3001 if the modifier does not match the prior authorization.