MedicaidReimbursementHigh impact
BT2024159: Reminder about changes to physician reimbursement adjustment policies; FFS effective date changed
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Apr 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) is implementing physician reimbursement adjustment policy changes that align with Medicare policies, effective retroactively for fee-for-service claims with dates of service on or after April 1, 2024. The changes include new practitioner adjustment percentages, procedure-based adjustments for multiple surgeries and bilateral procedures, and site-of-service payment adjustments using Medicare facility practice expense RVUs.
Action Required
Immediately: Billing team must update system settings to apply new practitioner adjustment percentages (APRNs 85%, CRNAs 50% with QX or 100% with QZ, PAs 85%, LCSWs 75%, etc.) for all IHCP fee-for-service claims with dates of service on or after April 1, 2024. Update multiple surgery billing to use Medicare rules with modifier 51. Review and resubmit any FFS claims from April 1, 2024 forward that received incorrect adjustments. Monitor for system adjustments in CoreMMIS and additional publications regarding claim adjustments.