MedicaidReimbursementHigh impact
BT202426: IHCP announces updates to physician reimbursement adjustment policies
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) has updated physician reimbursement adjustment policies to align with Medicare rates at 100%, moving from Indiana Medicaid policies to Medicare policies where applicable. The changes affect practitioner adjustments, procedure-based adjustments, and site-of-service payments, with different reimbursement percentages for various provider types and modifiers.
Action Required
Immediately: Billing team must verify that all Indiana Medicaid claims with dates of service on or after January 1, 2024 receive proper reimbursement adjustments according to the new Medicare-based policies. Update billing system to apply correct percentage adjustments for different provider types (e.g., APRNs at 85%, CRNAs at 50% with QX modifier or 100% with QZ modifier, LCSWs at 75%). Monitor for automatic reprocessing of affected fee-for-service claims through CoreMMIS and managed care entities. Update encounter forms to ensure proper modifier usage (QX, QZ, HM, 62, 80, 81, 82, AS, 50, 51) based on provider type and procedure circumstances.