MedicaidBilling CodesHigh impact
BT2025169: IHCP and DDARS announce changes to waiver services, effective Jan. 1, 2026
Indiana Medicaid (IHCP)·IN · PM&R (Physical Medicine & Rehab), Psychiatry, Physical Therapy +1 more·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana Medicaid is sunsetting several waiver services on Dec. 31, 2025 and adding new behavioral support services and self-directed care options starting Jan. 1, 2026. This includes replacing Basic Behavior Management with a new three-component Behavioral Support Services model and introducing self-directed service options across multiple waivers.
Action Required
By Dec. 31, 2025: Billing team must stop using sunset procedure codes H0004 U7 U5 U2, H2020 U7 U5 U1, H2020 U7 U5 U2, and consumer-directed S5125 codes. By Jan. 1, 2026: Update billing system with new Behavioral Support Services codes (H0004 with UA, UB, UC modifiers) and all new self-directed service codes with proper time limits and budgeted rates. Update encounter forms to reflect quarterly authorization for behavioral services instead of annual. Train staff on new modifier combinations and service limitations.