Last updated 05/08/2025
Email, Phone & Fax
The IHCP is updating the telehealth and virtual services code set to allow additional services to be reimbursed when rendered via telephone or other audio-only telecommunications systems. Effective for dates of service (DOS) on and after Dec. 9, 2022, the procedure codes in Table 1 (located in the memo) will be allowable when provided as audio-only telehealth.
As published in IHCP Bulletin BT202239, for a practitioner to receive reimbursement for telehealth services, the procedure code must be listed in the telehealth and virtual services code set (see Telehealth and Virtual Services Codes, accessible from the Code Sets page), and must be a service for which the member is eligible. Additionally, the claim detail must have:
One of the following place of service (POS) codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
One of the following modifiers:
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
- 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
Modifier 93 (audio-only) is allowable only for certain, designated telehealth services.
Updated List Telehealth Code List. (Feb. 6, 2025).
Lung Cancer screening code G0296 may be provided via audio-only. (BT2024151 (Sept. 26, 2024)).
SOURCE: IN Health Coverage Programs “IHCP expands and clarifies telehealth coverage” BT202297 (Nov. 8, 2022), p. 1. (Accessed May 2025).
Most telehealth services must be provided via video and audio, although a few designated telehealth services can be provided via audio only. Audio-only delivery is allowable for all nonhealthcare virtual services.
Nonhealthcare virtual services must be billed with POS code 02 or 10. These services and do not require modifiers 93 or 95. All services in this category can be provided either through audio and video technology or via audio only.
Unless the practitioner has an established relationship with the patient, telehealth does not include the use of electronic mail, an instant messaging conversation, facsimile, internet questionnaire or an internet consultation.
Intensive Outpatient Treatment (IOT) delivered via telehealth must have a video component. Telehealth IOT cannot be audio-only (for example, via telephone). Telehealth IOT cannot be billed with modifier 93. Cameras must be on and used by IOT participants for the entire duration of the session, with camera-off time documented and not billable.
Dental services cannot be delivered via audio-only telehealth.
No Applied Behavioral Analysis services are reimbursable when delivered via audio-only telehealth.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Oct. 30, 2024) p. 1, 7. (Accessed May 2025).
For certain telehealth services, an audio-only modifier (93) can be used to signify when a service is delivered via audio-only telehealth. Services eligible for reimbursement when billed with this new modifier are identified within this finalized code set. All other codes must be delivered via video and audio telehealth. See Bulletin for code set. Effective July 21, 2022 through end of 2022 at which point they will be re-evaluated for 2023.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT 202239 (May 19, 2022). (Accessed May 2025).
The IHCP will continue to allow and offer reimbursement for audio-only telehealth. The IHCP will continue to explore the option of audio-only telehealth and its effectiveness in delivering healthcare services and provide updates when more specific policy details have been determined. Until further notice, audio-only telehealth services should be billed according to the guidance released in BT2020106 and used only when the care can be properly delivered via audio-only telehealth.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed May 2025).
Physical Therapy
The physical therapy assistant (PTA) is precluded from performing or interpreting tests, conducting initial or subsequent assessments, or developing treatment plans. See the Covered Procedures for Physical Therapist Assistants section for details. The PTA is required to meet with the supervising physical therapist each working day to review treatment, unless the physical therapist or physician is on the premises to provide constant supervision. The consultation can be either face-to-face or by telephone.
SOURCE: IN Therapy Services Module, Nov 27, 2024, p. 6, (Accessed May 2025).
Home and Community-Based Services
Caregiver Coaching provided in the home of the participant, virtually or telephonically and through Health Insurance Portability and Accountability Act (HIPAA) secure communication platforms that allow for real time and asynchronous communication between caregivers and caregiver coaches and collaboration with waiver care managers/service coordinators.
Caregiver Coaching services may be delivered telephonically and through HIPPA secure electronic communication platforms that enable a caregiver coach and a caregiver to communicate efficiently and in a manner convenient to the caregiver.
SOURCE: IHCP Office of Medicaid Policy and Planning, Home and Community Based Services: Indiana PathWays for Aging Waiver, p. 50-51 (Apr. 4, 2025). (Accessed May 2025).
Home and Community Based Services Waivers
Caregiver Coaching provided in the community of the participant, virtually or telephonically or other identified location meaningful to the unpaid caregiver and through HIPAA secure communication platforms that allow for real-time and asynchronous communication between caregivers and caregiver coaches and collaboration with waiver case managers.
Caregiver Coaching services may be delivered telephonically and through HIPAA secure electronic communication platforms that enable a caregiver coach and a caregiver to communicate efficiently and, in a manner, convenient to the caregiver.
Provider agencies must capture any caregiver communications received through an electronic communication platform, such as an app or email, to facilitate the sharing of relevant information with care managers. Providers will communicate with care managers through traditional means to share any relevant information. The service does not require any specific percentage of in-person visits versus virtual visits.
SOURCE: IHCP Division of Disability and Rehabilitative Services, Home-and Community-Based Services Waivers, p. 245-246 (Apr. 4, 2025). (Accessed May 2025).
Adult Mental Health Habilitation Services
Habilitation and support is not permissible via audio-only telehealth modalities. The IHCP reimburses for H2014 – Skills training and development, per 15 minutes (see Table 2) when the service is rendered through an audiovisual telehealth modality.
If behavioral health assistance needs to be rendered via audio-only telehealth modalities, the following procedure codes are reimbursable via audio-only telehealth per IHCP policy and may be used in place of habilitation and support:
- H0038 – Self-help/peer service, per 15 minutes
- H2011 – Crisis intervention service, per 15 minutes For more information, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
These services (specific HPCCS Codes listed on pages 70, 74-75, 87) cannot be delivered via audio-only telehealth per IHCP policy, but can be delivered via audiovisual telehealth. If a member has eligibility to receive these services in person through the IHCP, then they are eligible to receive these services via telehealth. For more information, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
SOURCE: Division of Mental Health and Addiction, Adult Mental Health Habilitation Services Module (July 25, 2024), p. 64, 70,74- 75, 87. (Accessed May 2025).
Mobile Crisis Intervention
Follow-up stabilization services: Follow-up contacts in-person, via phone, or telehealth up to 14 days following initial crisis intervention and can be billable up to 90 days.
SOURCE: ICHP Bulletin BT 2023173 (Dec. 12, 2023), p. 3. (Accessed May 2025).
Federally Qualified Health Centers/Rural Health Clinics
Dental services do not require a modifier indicating the method of telehealth delivery. Dental services cannot be provided via audio-only telehealth. The only dental service that FQHCs and RHCs can bill as telehealth is D0140 – Limited oral evaluation – problem focused.
SOURCE: IHCP Federally Qualified Health Centers and Rural Health Clinics, p. 6 (May 7, 2024). (Accessed May 2025).
Telephone codes and G2025 listed as exempt from Healthy Indiana Plan (HIP) copayment, effective for DOS on or after July 1, 2024.
SOURCE: ICHP Bulletin BT 202476 (June 4, 2024). (Accessed May 2025).
Last updated 05/08/2025
Live Video
POLICY
The Indiana Health Coverage Programs (IHCP) covers select medical, dental and remote patient monitoring services delivered via telehealth. IHCP coverage is also available for the virtual delivery of certain nonhealthcare services (such as case management) for members who are eligible to receive such services. For applicable procedure codes, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. Most telehealth services must be provided via video and audio, although a few designated telehealth services can be provided via audio only. Audio-only delivery is allowable for all nonhealthcare virtual services.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct. 30 2024), p. 1. (Accessed May 2025).
Indiana Code requires reimbursement for medically necessary telehealth services for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Community Mental Health Centers, Critical Access Hospitals, a home health agency under IC 16-27-1, and a provider determined by the office to be eligible, providing a covered telehealth service.
SOURCE: IN Code, 12-15-5-11 (Accessed May 2025).
All services delivered through telehealth are subject to the same limitations and restrictions as they would be if delivered in-person
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed May 2025).
In any telemedicine encounter, there will be the following:
- A distant site;
- An originating site;
- An attendant to connect the patient to the provider at the distant site; and
- A computer or television monitor at the distant and originating sites to allow the patient to have real-time, interactive; and face-to-face communication with the distant provider via IATV technology.
SOURCE: IN Admin. Code, “Article 5,” Title 405, 5-38-3 & 4., (Accessed May 2025).
ELIGIBLE SERVICES/SPECIALTIES
Providers are allowed to use telehealth for the medical, dental and remote patient monitoring services listed in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. The following services may not be provided using telehealth:
- Surgical procedures
- Radiological services
- Laboratory services
- Anesthesia services
- Durable medical equipment (DME)/home medical equipment (HME) services
- Transportation services
Office visits conducted via telehealth are subject to existing service limitations for office visits. Telehealth office visits billed using applicable codes from Telehealth and Virtual Services Codes (accessible from the Code Sets page at in.gov/medicaid/providers) are counted toward the member’s office visit limit. See the Evaluation and Management Services module for information about office visit limitations.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 2-3. Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, p. 2 June 8, 2021, (Accessed May 2025).
Lung cancer screening code (G2096) added to eligible telehealth services list as well as other additional codes.
SOURCE: IHCP Bulletin BT2024151 (Sept. 20, 2024). IHCP Bulletin BT2024207 (Dec. 19, 2024) (Accessed May 2025).
Group psychotherapy services and 2024 Annual HCPCS Codes Update – new codes added.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202425 (Feb. 29, 2024). (Accessed May 2025).
IHCP reimbursement for telehealth services is limited to the medical, dental and remote patient monitoring procedure codes listed in the telehealth code set (see the Telehealth Services Allowed and Excluded section). Additionally, the rendering NPI on the claim must be enrolled in the IHCP under one of the specialties allowable for telehealth services (see the Practitioners Eligible to Provide Telehealth Services section). All services delivered via telehealth must be billed with one of the following place of service (POS) codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
The procedure code billed must appear on the telehealth code set (Tables 1–3 of Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers). IIn addition, an appropriate telehealth modifier may be required, depending on the type of service:
Medical services – All medical services delivered via telehealth (with the exception of services delivered through a Home- and Community-Based Services [HCBS] or Money Follows the Person [MFP] program) require one of the following modifiers:
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
- 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct. 30, 2024), p. 3-4 Indiana Health Coverage Programs ICHP Bulletin BT202249 (June 30, 2022). (Accessed May 2025).
In December 2022, IHCP expanded and clarified telehealth coverage and note it will be effective December 9, 2022. The updated coverage applies to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid. The telehealth and virtual services code set is used by both fee-for-service (FFS) and managed care delivery systems. This updated code set will remain in place for the remainder of 2022 and 2023, and will be reevaluated by the Office of Medicaid Policy and Planning (OMPP) at the end of 2023.
Updated Code Set as of February 6, 2025, Note includes a code for genetic counseling. IHCP Bulletin BT 202520 (Feb. 6, 2025). (Accessed May 2025).
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT 202520 (Feb. 5, 2025). Past bulletins: Indiana Health Coverage Programs (IHCP) Bulletin, BT202425 (Feb. 29, 2024). IN Health Coverage Programs (IHCP) Bulletin BT 202297 (Nov 8, 2022). Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, p. 2 June 8, 2021, ICHP BT2020106 Indiana Health Coverage Programs ICHP Bulletin BT 202239 (May 19, 2022). (Accessed May 2025).
As published in IHCP Bulletin BT202239, for a practitioner to receive reimbursement for telehealth services, the procedure code must be listed in the telehealth and virtual services code set, and must be a service for which the member is eligible. Additionally, the claim detail must have:
One of the following place of service (POS) codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
One of the following modifiers:
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
- 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
Modifier 93 (audio-only) is allowable only for certain, designated telehealth services. Effective Dec. 9, 2022, the IHCP will allow reimbursement for the telehealth services specified in Table 1 when billed with the appropriate POS code and the audio-only modifier (93).
SOURCE: Indiana Health Coverage Programs ICHP Bulletin BT202297 (Nov 8, 2022), p. 1. (Accessed May 2025).
A valid FQHC or RHC encounter is defined as a face-to-face visit (either in person or via telehealth) between an IHCP member and a qualifying practitioner (see the Rendering Providers section) at an FQHC, RHC or other qualifying, non-hospital setting. When billing valid encounters provided by telehealth, When billing valid telehealth encounters, the encounter code (T1015 or D9999) should be billed as usual, and each service provided during the encounter must include an appropriate telehealth POS code (02 or 10) and telehealth modifier (93 or 95), as described in the FQHC and RHC Telehealth Services section of the Telehealth and Virtual Services module.
SOURCE: Medicaid Federally Qualified Health Centers and Rural Health Clinics Module, (Jan 2022 edition, published May 7, 2024), p. 10, 12, (Accessed May 2025).
When the FQHC or RHC is the distant site, the service provided by the FQHC or RHC must meet the requirements both for a valid encounter and for an approved telehealth service. The claim must include the following:
- Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 10, 11, 12, 31, 32, 50 or 72
- One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30 2024), p. 6 (Accessed May 2025).
For purposes of a community mental health center, telehealth services satisfy any face to face meeting requirement between a clinician and consumer.
SOURCE: IN Code, 12-15-5-11(f) IHCP Division of Mental Health and Addiction, Adult Mental Health Habilitation Services (July 25, 2024), p. 20; IHCP Division of Mental Health and Addiction, Behavioral and Primary Healthcare Coordination Service (Aug 29, 2024),. (Accessed May 2025).
Adult Mental Health Habilitation Services
Adult Mental Health Habilitation (AMHH) Home- and Community-Based Habilitation and Support services are individualized services provided face to face or via telehealth according to Indiana Administrative Code (IAC) that are focused on the member’s health, safety and welfare. Valid telehealth services can be found on Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers
Program standards for Adult Mental Health Habilitation (AMHH) Therapy and Behavioral Support Services and Addiction Counseling include the following:
- Services may be provided face to face or with telehealth according to the IAC with the member or with family members or nonprofessional caregivers with or without the member present.
For Medication Training and Support, program standard for these services include that services provided that are not face-to-face or telehealth, according to the IAC, with the member must meet the following standards:
- The member must be the focus of the service.
- Documentation must support how the service benefits the member.
SOURCE: IHCP Division of Mental Health and Addiction, Adult Mental Health Habilitation Services (July 25, 2024), p. 61, 63, 69, 73, 86 (Accessed May 2025).
Behavioral and Primary Healthcare Coordination (BPHC) Services
Telehealth may be used for clinical evaluations in the BPHC application process, for developing the Individualized Integrated Care Plan (IICP), and ongoing review of the IICP.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Behavioral and Primary Healthcare Coordination Services (Aug. 29, 2024). (Accessed May 2025).
The Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) and Division of Mental Health and Addiction (DMHA) received approval from the Centers for Medicare & Medicaid Services (CMS) to renew the Behavioral and Primary Healthcare Coordination (BPHC) service program. The renewal will go into effect on June 1, 2024. The renewal of BPHC programming and services allows for an additional five years of the BPHC service. The BPHC service program offers one service, which consists of coordinated healthcare activities to manage the behavioral health/addiction and physical healthcare needs of eligible members. The service includes logistical support, advocacy and education to assist individuals in navigating the healthcare system, and activities that help members gain access to needed physical and behavioral health services to manage their health conditions. The following updates are included in the BPHC program:
- Quality improvement (QI) activities will verify services provided fulfill the person-centered plan (PCP) established with the individual receiving services.
- Medicaid allowances for telehealth services.
SOURCE: Indiana Health Coverage Programs, IHCP Bulletin, BT202440 (April 4, 2024). (Accessed May 2025).
Nonhealthcare Virtual Services
Nonhealthcare virtual services are services centering on patient wellness and case management that are delivered between a patient and a provider via interactive electronic communications technology. A licensed practitioner listed under IC 25-1-9.5-3.5 is not required to perform these services, as they are not considered healthcare services under the definition listed in IC 25-1-9.5-2.5. For a list of nonhealthcare procedure codes allowable for virtual delivery, see the Procedure Codes for Nonhealthcare Virtual Services table in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
Nonhealthcare virtual services must be billed with POS code 02 or 10. These services and do not require modifiers 93 or 95. All services in this category can be provided either through audio and video technology or via audio only.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 5 (Accessed May 2025).
Nonhealthcare virtual services take place between a patient and a provider via interactive electronic communications technology. These services do not require a licensed practitioner listed in IC 25-1-9.5-3.5 to perform the service virtually, as the services are not considered healthcare services under the definition listed in IC 25-1-9.5-2.5 and, therefore, do not fall under the definition of telehealth by the IHCP. As specified in Table 2, nonhealthcare virtual services must be billed with a POS of 02 or 10, and do not require modifiers 93 or 95. All services in this category can be provided via audio only.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed May 2025).
Telehealth Dental Services
The use of modifiers 95 or 93 is not required for dental services delivered via telehealth. Dental services cannot be delivered via audio-only telehealth.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Feb. 29, 2024), p. 4, Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed May 2025).
Intensive Outpatient Treatment via Telehealth
The IHCP reimburses for intensive outpatient treatment (IOT) services (procedure codes H0015 and S9480) when delivered via telehealth. The IHCP is approaching this temporary policy expansion as a pilot initiative, where any healthcare provider engaging in telehealth IOT will be opting in to the analysis of the efficacy of this model through data collection and analysis. This data collection and analysis will be administered through the state and is intended to have a minimal administrative impact on providers. All providers submitting claims for telehealth IOT will automatically be included in the study and are expected to participate by providing data if requested. Telehealth IOT will be available for 12 months after which the data collected will be analyzed by the Division of Mental Health and Addiction (DMHA). IOT requires prior authorization for medical necessity, regardless of whether it is delivered in person or via telehealth. See manual for other criteria.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct. 30, 2024), p. 7 (Accessed May 2025).
After receiving feedback from providers over an allotted 30-day period, the IHCP has determined that IOT services (procedure codes H0015 and S9480) will be reimbursable when delivered via telehealth. This service will be added to the 2022 telehealth and virtual services code set. See bulletin for more instructions.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed May 2025).
With the exception of services billed by a federally qualified health center (FQHC) or rural health clinic (RHC) (see the Telehealth Services for FQHCs and RHCs section) or RPM services billed by a home health agency (see the RPM Billing and Reimbursement for Home Health Agencies section), the payment for telehealth services is equal to the current Fee Schedule amount for the procedure codes billed (see the IHCP Fee Schedules page at in.gov/medicaid/providers).
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 3, (Accessed May 2025).
Skills Training and Development Rendered Via Telehealth
As published in BT202249, the IHCP reimburses for H2014 – Skills training and development, per 15 minutes when the service is rendered through an audiovisual telehealth modality. Skills training and development is covered only for members who have access to Medicaid Rehabilitation Option (MRO) services. The OMPP, in partnership with the Division of Mental Health and Addiction (DMHA), developed the following service parameters for when telehealth delivery satisfies the “face-to-face” contact required for this service. Providers are expected to have these service parameters in place by Dec. 9, 2022, when rendering skills training and development via telehealth. See bulletin for additional information.
SOURCE: IHCP Expands and Clarifies Telehealth Coverage BT 202297 (Nov. 8, 2022), p. 2-3. (Accessed May 2025).
Home and Community-Based Services
Caregiver Coaching provided in the home of the participant, virtually or telephonically and through Health Insurance Portability and Accountability Act (HIPAA) secure communication platforms that allow for real time and asynchronous communication between caregivers and caregiver coaches and collaboration with waiver care managers/service coordinators.
Caregiver Coaching services may be delivered telephonically and through HIPPA secure electronic communication platforms that enable a caregiver coach and a caregiver to communicate efficiently and in a manner convenient to the caregiver.
SOURCE: IHCP Office of Medicaid Policy and Planning, Home and Community Based Services: Indiana PathWays for Aging Waiver, p. 50-51. (Sept. 9, 2024) (Accessed May 2025).
Mobile Crisis Intervention Services
Follow-up stabilization services: Follow up contacts in-person, via phone, or telehealth up to 14 days following initial crisis intervention and can be billable up to 90 days.
SOURCE: IHCP Adding Coverage for Mobile Crisis Intervention Services BT 202364 (Jun. 15, 2023) & IHCP Bulletin ICHP Covers Mobile Intervention Services Retroactive to July 1, 2023 (Dec. 12, 2023). (Accessed May 2025).
Home Health Services
The IHCP covers telehealth services provided by home health agencies.
SOURCE: IHCP Home Health Services Module (Oct. 3, 2023), p. 8. (Accessed May 2025).
The medical necessity for home health services must be certified by the member’s qualified treating practitioner (physician, nurse practitioner, clinical nurse specialist or physician assistant). The IHCP continues to adhere to Code of Federal Regulations 42 CFR 440.70(f), which requires a documented face-to-face encounter to occur within the 90 days before or within the 30 days after the start of home health services for the initial certification of medical necessity of home health services. An encounter must also be documented if there is an interruption in home health services. For long-term home health services, an encounter must be documented annually.
The face-to-face encounter may occur through telehealth in accordance with the policies and procedures described in the Telehealth and Virtual Services module.
SOURCE: IHCP Bulletin BT202545 (April 1, 2025). (Accessed May 2025).
Opioid Treatment Program
POS codes 02 – Telehealth provided other than in patient’s home and 10 – Telehealth provided in patient’s home can be used when billing OTP services. It should be noted that by end of 2023, the Office of Medicaid Policy and Planning will be reevaluating the telehealth service codes. If any changes to these POS codes occur, it will be noted in a future bulletin.
SOURCE: IHCP Bulleting BT 2023151 (Nov. 2, 2023), p. 2. (Accessed May 2025).
Adult Mental Health Habilitation Services
Evaluations and reassessments may be conducted face-to-face or via telehealth. Certain information must be included and in some cases specific requirements must be met. See manual for more information.
All clients being considered for telehealth services must be given the option of in-person services prior to telehealth being selected as modality.
The number of in-person visits and the percentage of time telehealth will be the delivery method of service will be based on what is clinically appropriate and in agreement with the consumer and/or legal guardian.
The use of telehealth should protect against isolating participants by offering services that are in person and shall be invoked to prioritize and facilitate community integration.
Telehealth services shall consider and respond to all accessibility needs, including whether hands-on or physical assistance is needed to render the service.
Telehealth services must ensure the health and safety of the individual receiving services by adhering to all abuse, neglect and exploitation prevention practices that apply to in-person treatment, as well as by providing participants with resources on how to report incidences of abuse, neglect and exploitation.
Habilitation and support is not permissible via audio-only telehealth modalities. The IHCP reimburses for H2014 – Skills training and development, per 15 minutes (see Table 2) when the service is rendered through an audiovisual telehealth modality.
These services (specific HPCCS Codes listed on pages 70, 75, 87) cannot be delivered via audio-only telehealth per IHCP policy, but can be delivered via audiovisual telehealth. If a member has eligibility to receive these services in person through the IHCP, then they are eligible to receive these services via telehealth. For more information, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
Adult Mental Health Habilitation (AMHH) Addiction Counseling services consist of a series of planned and organized face-to-face or telehealth, according to Indiana Administrative Code. Addiction professionals and other clinicians provide counseling interventions that work toward the member’s recovery goals identified in the Individualized Integrated Care Plan (IICP) as they pertain to substance use-related disorders. Valid telehealth services can be found on Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers
T1016 – Care Coordination – If a member has eligibility to receive these services in person through the IHCP, then they are eligible to receive these services via telehealth. For more information, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. (See manual for more detail).
Adult Mental Health Habilitation (AMHH) Medication Training and Support services involve face-to-face or telehealth according to Indiana Administrative Code, services provided to the member, in an individual or group setting, for the purpose of:
- Monitoring medication compliance
- Providing education and training about medications
- Monitoring medication side effects
- Providing other nursing or medical assessment
SOURCE: Division of Mental Health and Addiction, Adult Mental Health Habilitation Services Module (July 25, 2024), p. 20, 41, 56, 63-64, 69, 70, 73, 75, 81, 83, 85, 86, 87. (Accessed Feb. 2025).
Outpatient Institutional Claims for Telehealth Services
For providers that use the outpatient institutional claim (UB-04 claim form, IHCP Provider Healthcare Portal institutional claim or 837I electronic transaction), services delivered via telehealth should be billed as follows:
- If the service can be billed with a procedure code, providers should enter the procedure code and, if applicable, use the appropriate modifier (93 or 95) to indicate that the service was delivered via telehealth. POS codes are not used on outpatient claims.
- If the service cannot be billed with a procedure code (for example, procedure codes cannot be used with revenue codes 905 or 906), the service should be billed as it normally would if delivered in person. Procedure code, modifier and POS code requirements do not apply in this case. Providers are advised to mark in their patient records that the service was delivered via telehealth.
In either case, the service provided must be a one that is allowable for telehealth delivery, as indicated on the telehealth code set (Tables 1–3 of Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers).
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 4-5, (Accessed May 2025).
Applied Behavioral Analysis Therapy Services via Telehealth
The IHCP provides coverage for applied behavior analysis (ABA) therapy when medically necessary for the treatment of autism spectrum disorder (ASD). All ABA therapy services require prior authorization. Besides the PA criteria outlined in the Behavioral Health Services module, procedure codes 97155 and 97156 are subject to the following additional requirements when rendered via telehealth:
- Credentialed registered behavior technicians (RBTs) may not deliver any ABA service via telehealth. Only a health service provider in psychology (HSPP) or a licensed or board-certified behavior analyst (BCBA) are eligible for using telehealth when supervising the delivery of ABA services remotely.
- Procedure code 97155 is reimbursable via telehealth only when an HSPP or BCBA is providing guidance/supervision to an RBT remotely, and the RBT is rendering adaptive behavioral treatment in person to the member.
- All ABA services must include synchronous audiovisual interaction. No ABA services are reimbursable when delivered via audio-only telehealth.
The complete list of procedure codes for applied behavior analysis therapy can be found in Behavioral Health Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. Procedure codes 97155 and 97156 are the only two ABA services that are allowable as telehealth.
For dates of service on and after Jan. 1, 2024, all ABA services must be billed with an appropriate modifier to indicate the credentials of the practitioner delivering the service. When ABA services are delivered via telehealth, modifier 95 must also be included.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 8, (Accessed May 2025).
Addiction Counseling, Behavioral Health Counseling & Therapy, Medication Training and Support
Addiction Counseling, Behavioral Health Counseling, Medication Training and Support, and Skills and Training Development may be delivered via an audiovisual telehealth modality. This service is not permissible via audio-only telehealth modalities. If behavioral health assistance needs to be rendered via audio-only telehealth modalities, the following procedure codes are reimbursable via audio-only telehealth:
H0038 – Self-help/peer service, per 15 minutes
H2011 – Crisis intervention service, per 15 minutes
See the Behavioral Health Services module for more information on the peer recovery and crisis intervention services. See the Telehealth and Virtual Services module for more information about rendering and billing for telehealth services.
Skills Training and Development may be delivered via an audiovisual telehealth modality when the following service parameters are met:
- All members being considered for telehealth services must be given the option of in-person services prior to telehealth being selected as the modality.
- The member must indicate that telehealth is their preferred method for receiving services.
- The member must have documented acknowledgement of receipt of informed consent about risks and benefits of the telehealth modality.
- Within 30 days of the first telehealth session occurring, a licensed behavioral health practitioner, HSPP or overseeing psychiatric medical professional must document verification that telehealth is thought to be an effective modality for the member based on symptoms, severity and access to services.
- Use of the telehealth modality must be formally reviewed with the member every 90 days and adjusted based on need or efficacy.
- If the member is not progressing or stabilizing, evaluation of how treatment will be adjusted must be documented. This adjustment may include increasing in-person sessions.
- All Skills Training and Development sessions should have clearly documented connection to diagnosis and/or treatment goals.
- At minimum, the member must have an in-person session with a member of the treatment team every 90 days. This session may be in the home, community or office setting.
SOURCE: IHCP Medicaid Rehabilitation Option Services, p. 10, 14, 22, 29. (Feb. 27, 2024). (Accessed May 2025).
ELIGIBLE PROVIDERS
In response to Indiana House Enrolled Act 1352 (2023), the Indiana Health Coverage Programs (IHCP) has implemented a new telehealth-only provider enrollment for providers that wish to perform only telehealth services (with no physical site where patients are seen) and that meet the Indiana licensure and other special requirements outlined in this bulletin. This telehealth-only provider enrollment option is currently available on the IHCP Provider Healthcare Portal. See bulletin for more details.
SOURCE: IHCP Bulletin: IHCP to Begin Enrollment for Telehealth-Only Providers BT202417 (Feb. 15, 2024). (Accessed May 2025).
The practitioners listed in IC 25-1-9.5-3.5 are authorized to provide telehealth services under the scope of their licensure within the state of Indiana.
The IHCP will allow these practitioners to provide telehealth services and receive reimbursement for IHCP services, within the established IHCP billing rules and policies. Providers not on this list are not allowed to practice telehealth or receive IHCP reimbursement for such services, even under the supervision of one of these listed practitioners. Providers rendering services within the state of Indiana are encouraged to have a telehealth provider certification filed with the Indiana Professional Licensing Agency. Providers rendering services out of state are required to have a telehealth provider certification under IC 25-1-9.5-9; see the Out-of-State Telehealth Providers section for more information.
NOTE: Not all practitioners that are authorized to provide telehealth services are allowed to enroll as rendering providers in the IHCP. Those that are not eligible for IHCP enrollment must bill under the IHCP-enrolled supervising practitioner’s National Provider Identifier (NPI), using the appropriate modifiers (as applicable). The rendering NPI entered on the claim must be enrolled under a specialty that is allowable for telehealth.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 2, (Accessed May 2025).
For a provider to be reimbursed for telehealth services under the IHCP, the provider must be enrolled with the IHCP and be a licensed practitioner listed in IC 25-1-9.5-3.5. Providers rendering services in state are also encouraged to have a telehealth provider certification filed with the Indiana Professional Licensing Agency. Providers rendering services out of state are required to have a telehealth provider certification under IC 25-1-9.5-9.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed May 2025).
The IHCP will allow these providers to provide telehealth services and receive reimbursement for IHCP services, within the established IHCP billing rules and policies:
- A behavior analyst licensed under IC 25-8.5
- A chiropractor licensed under IC 25-10
- A dental hygienist licensed under IC 25-13*
- The following:
- A dentist licensed under IC 25-14
- An individual who holds a dental residency permit issued under IC 25-14-1-5*
- An individual who holds a dental faculty licensed under IC 25-14-1-5.5*
- A diabetes educator licensed under IC 25-14.3*
- A dietitian licensed under IC 25-14.5*
- A genetic counselor licensed under IC 25-17.3
- The following:
- A physician licensed under IC 25-22.5
- An individual who holds a temporary medical permit under IC 22-22.5-5-4*
- A nurse licensed under IC 25-23*
- An occupational therapist licensed under IC 25-23.5
- Any behavioral health and human services professional licensed under IC 25-23.6
- An optometrist licensed under IC 25-24
- A pharmacist licensed under IC 25-26*
- A physical therapist licensed under IC 25-27
- A physician assistant licensed under IC 5-27.5
- A podiatrist licensed under IC 25-29
- A psychologist licensed under IC 25-33
- A respiratory care practitioner licensed under IC 25-34.5*
- A speech-language pathologist or audiologist licensed under IC 25-35.6
Some providers (within the licensure citations above) marked with an asterisk may not be able to enroll as rendering providers in the IHCP and must bill under the IHCP-enrolled supervising practitioner’s National Provider Identifier (NPI) using the appropriate modifiers (as applicable). In addition, providers not on this list are not allowed to practice telehealth and/or receive IHCP reimbursement for such services, even under the supervision of one of these listed practitioners.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed May 2025).
Providers that can deliver healthcare services via telehealth must be listed as an authorized practitioner in SB 3(SEA 3). Providers not listed as authorized practitioners in SB 3(SEA 3) are not permitted to practice telehealth and/or receive IHCP reimbursement for telehealth services, even under the supervision of one of these listed practitioners.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202145, June 17, 2021. (Accessed May 2025).
The office shall reimburse the following Medicaid providers for medically necessary telehealth services:
- A federally qualified health center
- A rural health clinic
- A community mental health center
- A critical access hospital
- A home health agency licensed under IC 16-27-1.
- A provider, as determined by the office to be eligible, providing a covered telehealth service.
SOURCE: IN Admin Code, “Article 5” 405 5-38-4(3) & IN Code, 12-15-5-11. (Accessed May 2025).
The office may not impose any distance restrictions on providers of telehealth activities or telehealth services. Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
SOURCE: IN Code, 12-15-5-11 (Accessed May 2025).
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
Special billing considerations apply for federally qualified health center (FQHC) and rural health clinic (RHC) providers. FQHC and RHC providers may bill for telehealth services if the service rendered is considered a valid FQHC or RHC encounter (as defined in the Federally Qualified Health Centers and Rural Health Clinics module) and a covered telehealth service (as defined by the Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers). Subject to the following criteria, reimbursement is available to FQHCs and RHCS when they are serving as either the distant site or the originating site for telehealth services.
When the FQHC or RHC is the distant site, the service provided by the FQHC or RHC must meet the requirements both for a valid encounter and for an approved telehealth service. The claim must include the following:
- Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 10, 11, 12, 31, 32, 50 or 72
- One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct 30, 2024), p. 6, Indiana Health Coverage Programs, Federally Qualified Health Centers and Rural Health Clinics, p. 6 (May 7, 2024). (Accessed May 2025).
A valid FQHC or RHC encounter is defined as a face-to-face visit (either in person or via telemedicine) between an IHCP member and a qualifying practitioner (see the Rendering Providers section) at an FQHC, RHC, or other qualifying, non-hospital setting.
SOURCE: Medicaid Federally Qualified Health Centers and Rural Health Clinics Module, Jan. 1, 2022 (published May 7, 2024), p. 4, (Accessed May 2025).
Non-Eligible Providers
IHCP does not reimburse the following provider types for telemedicine:
- Ambulatory surgical centers;
- Outpatient surgical services;
- Home health agencies or services (For information about home health agency reimbursement for telehealth services, see the Telehealth Services section);
- Radiological services;
- Laboratory services;
- Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled;
- Anesthesia services or nurse anesthetist services;
- Audiological services;
- Chiropractic services;
- Care coordination services;
- Durable medical equipment, and home medical equipment providers
- Optical or optometric services;
- Podiatric services;
- Physical therapy services;
- Transportation services;
- Services provided under a Medicaid home and community-based services waiver.
- Provider to provider consultations
SOURCE: IN Admin. Code, “Article 5” Title 405, 5-38-4 (Accessed May 2025).
ELIGIBLE SITES
Telehealth services may be rendered in an inpatient, outpatient or office setting. The provider and/or patient may be located in their home during the time of these services. For IHCP reimbursement of telehealth services, the member must be physically present at the originating site and must participate in the visit.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct. 30, 2024), p.1 , (Accessed May 2025).
The office may not impose any distance restrictions on providers of telehealth activities or telehealth services. Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
SOURCE: IN Code, 12-15-5-11 (Accessed May 2025).
Per Indiana Code IC 25-1-9.5-3, “originating site” means any site at which a patient is located at the time healthcare services through telehealth are provided to the individual. Accordingly, eligible providers may be reimbursed for procedure code Q3014 when the provider location is acting as an originating site for telehealth services.
SOURCE: ICHP Expands Procedure Code Q3014 to Additional Providers BT 202332 (Apr. 25, 2023). Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct. 30, 2024), p. 5(Accessed May 2025).
Separate reimbursement for a provider at the originating site is payable only if that provider’s presence is medically necessary. Adequate documentation must be maintained in the patient’s medical record to support the need for the provider’s presence at the originating site during the visit. Such documentation is subject to post-payment review. If a healthcare provider’s presence at the originating site is medically necessary, billing of the appropriate evaluation and management code is permitted.
SOURCE: IN Admin. Code, “Article 5” Title 405, 5-38-4 (Accessed May 2025).
GEOGRAPHIC LIMITS
The office may not impose any distance restrictions on providers of telehealth activities or telehealth services. Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
SOURCE: IN Code 12-15-5-11 (Accessed May 2025)
Medicaid may not require:
- A provider that is licensed, certified, registered, or authorized with the appropriate state agency or board and exclusively offers telehealth services (as defined in IC 12-15-5-11(a)) to maintain a physical address or site in Indiana to be eligible for enrollment as a Medicaid provider.
- A telehealth provider group with providers that are licensed, certified, registered, or authorized with the appropriate state agency or board to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group.
SOURCE: IN Code 12-15-11-10 (Accessed May 2025).
FACILITY/TRANSMISSION FEE
The current IHCP Telehealth and Virtual Services Codes (accessible from the Code Sets page at in.gov/medicaid/providers) includes coverage of procedure code Q3014 – Telehealth originating site facility fee. Per Indiana Code IC 25-1-9.5-3, “originating site” means any site at which a patient is located at the time healthcare services through telehealth are provided to the individual. Accordingly, eligible providers may be reimbursed for procedure code Q3014 when the provider location is acting as an originating site for telehealth services.
If the originating site is a hospital or other location that bills on an institutional claim, HCPCS code Q3014 is reimbursable when billed with revenue code 780 – Telemedicine – General. If a different, separately reimbursable treatment room revenue code is provided on the same day as the telehealth service, the appropriate treatment room revenue code should also be included on the claim. Documentation must be maintained in the patient’s record to indicate that services were provided separately from the telehealth visit.
If the originating site is a physician’s office, clinic or other location that bills on a professional claim, POS code 02 must be used for Q3014, along with modifier 95. If other services are provided on the same date as the telehealth service, the medical professional should bill Q3014 as a separate line item from other professional services.
If the originating site is an FQHC or RHC, additional billing requirements apply. See the Telehealth Services for FQHCs and RHCs section.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Oct. 30, 2024), p. 5-6. (Accessed May 2025).
Effective immediately, and retroactive to dates of services (DOS) on or after July 21, 2022, the following specialties under provider type 11 – Behavioral Health Provider will be able to receive reimbursement for procedure code Q3014 when their offices or facilities are acting as an originating telehealth site for members:
- 616 – Licensed Psychologist
- 617 – Licensed Independent Practice School Psychologist
- 618 – Licensed Clinical Social Worker (LCSW)
- 619 – Licensed Marriage and Family Therapist (LMFT)
- 620 – Licensed Mental Health Counselor (LMHC)
- 621 – Licensed Clinical Addiction Counselor (LCAC)
SOURCE: ICHP Expands Procedure Code Q3014 to Additional Providers BT 202332 (Apr. 25, 2023). (Accessed May 2025).
When the FQHC or RHC is the originating site (the location where the patient is physically located), the FQHC or RHC may be reimbursed if it is medically necessary for a medical professional to be present with the member, and the service provided includes all components of a valid encounter code. The claim must include the following:
- Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 11, 12, 31, 32, 50 or 72
- Procedure code Q3014 – Telehealth originating site facility fee, billed with POS code 02 and modifier 95
- One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient
Note: The procedure code must appear on one of the code tables in this bulletin, and must be on the list of procedure codes allowable for an FQHC/RHC medical or dental encounter.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). IHCP Bulletin BT 202253 (July 14, 2022). (Accessed May 2025).
Last updated 05/08/2025
Remote Patient Monitoring
POLICY
The Indiana Health Coverage Programs (IHCP) covers select medical, dental and remote patient monitoring services delivered via telehealth.
Remote patient monitoring (RPM) is the scheduled monitoring of clinical data transmitted through technologic equipment in the member’s home. Data is transmitted from the member’s home to the provider location to be read and interpreted by a qualified practitioner. The technologic equipment enables the provider to detect minute changes in the member’s clinical status, which allows providers to intercede before the member’s condition advances and requires emergency intervention or inpatient hospitalization.
The IHCP has implemented a single RPM coverage and prior authorization policy to be used for fee-forservice (FFS) and managed care delivery systems. This coverage and PA policy applies to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.
The IHCP covers the RPM services listed in the Procedure Codes Covered for Remote Patient Monitoring table on Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. The service must be billed with POS code 02 or 10 and with modifier 95, as described in the Billing and Reimbursement for Telehealth Services section.
Prior authorization is required for specified RPM services, as indicated in the Procedure Codes for Remote Patient Monitoring Services table, in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
See manual for further details.
List of eligible CPT Codes (Feb. 6. 2025).
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Oct 30, 2024), p. 1, 9. (Accessed May 2025).
Effective for dates of service on or after July 21, 2022, procedure codes 99091, 99453, 99454, 99457 and 99458 will be covered RPM services. RPM or “remote patient monitoring technology” is listed under the definition of telehealth services per Indiana Code IC 25-1-9.5-6.
The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. This coverage and PA policy apply to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.
See Bulletin for more information.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202238 (May 17, 2022). (Accessed May 2025).
Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.
SOURCE: IN Code, 12-15-5-11(b)(5). (Accessed May 2025).
Medicaid will reimburse Home Health Agencies for telehealth services.
SOURCE: IN Admin Code Title 405, 1-4.2-3 & 5-16-2 & IHCP Home Health Services (Oct. 3, 2023), p. 2. (Accessed May 2025).
CONDITIONS
The member must meet one or more of the following criteria to receive prior authorization for an RPM service:
- Received an organ transplantation within one year following the date of surgery
- Had a surgical procedure (three-month service authorization following the date of surgery)
- Had one or more uncontrolled chronic conditions that significantly impaired the patient’s health or resulted in two or more related hospitalizations or emergency department visits in the previous 12 months
- Had been readmitted within 30 days for the same or similar diagnosis or condition
- Identified as having a high-risk pregnancy (up to three-month service authorization postpartum); see the Obstetrical and Gynecological Services provider reference module for more information about high-risk pregnancy
The duration of initial service authorization is six months, unless otherwise indicated. Reauthorizations will be permitted for select services as appropriate.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Oct. 30, 2024, p. 9-10. (Accessed May 2025).
The member must be receiving services from a home health agency. Member must initially have two or more of the following events related to one of the conditions listed below within the previous twelve months:
- Emergency room visit
- Inpatient hospital stay
An emergency room visit that results in an inpatient hospital admission does not constitute two separate events.
The two qualifying events must be for the treatment of one of the following diagnoses:
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Diabetes
SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(d). (Accessed May 2025).
Personal Emergency Response System
The following activities are allowed under the PERS service:
- Device installation
- Ongoing monthly maintenance of the device
- Electronic service that is usually a portal help button; however, it can also be an electronic device that includes, but is not limited to GPS or video monitoring service (Note: Remote monitoring will not be placed in participant bedrooms or bathrooms.)
SOURCE: IHCP Office of Medicaid Policy and Planning, Home and Community Based Services: Indiana PathWays for Aging Waiver, p. 80 (Sept 9, 2024). (Accessed May 2025).
PROVIDER LIMITATIONS
Reimbursement for home health agencies under certain conditions. A licensed registered nurse must perform the reading of transmitted health information provided from the member in accordance with the written order of the physician.
SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(d)(5),(Accessed May 2025).
OTHER RESTRICTIONS
The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. This coverage and PA policy apply to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.
See Bulletin for more information.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202238 (May 17, 2022). (Accessed May 2025).
Treating physician must certify the need for home health services and document that there was a face-to-face encounter with the individual.
SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(e) (Accessed May 2025).
Approved telehealth services are reimbursed separately from other home health services. The unit of reimbursement for telehealth services provided by an HHA is one (1) calendar day.
Reimbursement is available for telehealth services as follows:
- One-time amount per client of fourteen dollars and forty-five cents ($14.45) related to an initial face-to-face visit necessary to train the member to appropriately operate the telehealth equipment.
- One (1) payment of nine dollars and eighty-four cents ($9.84) for each day the telehealth equipment is used by a registered nurse (RN) to monitor and manage the client’s care in accordance with the written order from a physician.
Rates for telehealth services shall not be adjusted annually.
SOURCE: IN Admin Code, “Article 1” Title 405, 1-4.2-6 (Accessed May 2025).
