MedicaidCoverageMedium impact
BT2024198: IHCP updates CHW certification requirements; reminds providers of service coverage
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Pediatrics +1 more·Medical Policy
Effective date
Jul 1, 2018
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs updated certification requirements for Community Health Workers (CHWs) and provided comprehensive billing guidance. CHWs must be certified by approved entities and employed by IHCP-enrolled providers, with services billed using specific CPT codes for self-management education.
Action Required
Immediately: Billing teams serving Indiana Medicaid patients must ensure CHW services are billed using CPT codes 98960-98962 in 30-minute units with supervising provider as rendering provider. Document CHW certification from approved entities (ASPIN, DMHA, or INCHWA) and include CHW name in claim notes. Limit billing to 4 units per day and 24 units per month per member. Services are reimbursed at 50% of RBRVS.