MedicaidPrior AuthMedium impact
BT2024156: IHCP clarifies guidelines for using MRO billing and prior authorization codes
Indiana Medicaid (IHCP)·IN · Psychiatry·Prior Authorization
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid clarifies which MRO (Medicaid Rehabilitation Option) codes should be used for prior authorization requests versus billing claims. Some codes can be used for both PA and billing, while others are billing-only codes that cannot be requested in PA submissions.
Action Required
Immediately: Billing team must update prior authorization submission procedures for Indiana Medicaid MRO services. Use only the specified PA codes from Table 1 when requesting additional units (e.g., use H0004 HW for PA but can bill with H0004 HW, H0004 HW HR, or H0004 HW HS). Submit PA requests to Acentra Health via Atrezzo Provider Portal, fax, phone or mail. PA requests using billing-only codes will be rejected.