MedicaidDocumentationMedium impact
BT2024183: Structured Family Caregiving billing and claim restrictions applied to TBI and MFP
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Dec 18, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid now requires providers to include caregiver name and relationship information in claim notes when billing for Structured Family Caregiving services for TBI and MFP waivers. Additionally, Attendant Care and Home and Community Assistance services cannot be billed in the same month as Structured Family Caregiving.
Action Required
By December 18, 2024: Billing team must update claim submission process for Structured Family Caregiving services (S5140 with U7 modifiers) to include mandatory claim notes with caregiver name and relationship using specific format (NAME: First Last, REL: Parent of minor child/Spouse/Other). Update billing system to prevent same-month billing of S5125 (Attendant Care) or S5130 (Home and Community Assistance) with S5140. Claims without proper notes will be denied with EOB code 4405.