MedicaidCoverageMedium impact
BT202356: IHCP updates school-based services policy
Indiana Medicaid (IHCP)·IN · Physical Therapy, Occupational Therapy, Psychiatry +1 more·Medical Policy
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) expanded coverage for school-based services effective July 1, 2023, allowing reimbursement for medically necessary services provided under various educational plans including IEPs and 504 plans. All claims must be billed by school corporations using modifier TM and submitted to fee-for-service, not managed care.
Action Required
School-based healthcare providers must: 1) Bill all covered services under the school corporation's NPI (not individual practitioner NPIs), 2) Add modifier TM to all billing codes for mandated school-based services, 3) Submit claims to IHCP fee-for-service (Gainwell Technologies) instead of managed care entities, 4) Use specialty code 120 (School Corporation) and professional claim forms (CMS-1500). Services are exempt from prior authorization when included in approved educational plans.