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MedicaidBilling CodesLow impact

BT202480: IHCP adds Career Exploration and Planning service to FSW and CIH Waiver

Indiana Medicaid (IHCP)·IN · PM&R (Physical Medicine & Rehab), Occupational Therapy·Specialty Services
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Days to comply

Summary

Indiana Health Coverage Programs (IHCP) is adding Career Exploration and Planning services to the Community Integration and Habilitation (CIH) and Family Supports Waiver (FSW) programs effective July 1, 2024. New billing codes 97537 with specific modifiers are now available for individual ($37.06/hour) and group ($13.65/hour) career exploration services, limited to 20 hours per month for six months in any 12-month period.

Action Required

Action needed
By July 1, 2024: Billing team must add new procedure codes to billing system: CPT 97537 with modifiers U7+U5 for individual Career Exploration and Planning ($37.06/hour) and CPT 97537 with modifiers U7+U5+U2 for group services ($13.65/hour). Configure system to enforce limits of 20 hours per month for six months in any 12-month period. Update encounter forms if practice provides waiver services for individuals with disabilities.

Affected Billing Codes

97537