MedicaidPrior AuthMedium impact
BT2024109: IHCP recommends GP and GO modifiers with procedure code 97542
Indiana Medicaid (IHCP)·IN · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Claims & Billing
Effective date
Aug 19, 2024
We identified it
Jun 19, 2026
Summary
Starting August 19, 2024, CPT code 97542 (wheelchair management) will require GP or GO modifiers to match between prior authorization requests and claims for Indiana Medicaid. Claims without matching modifiers will be denied.
Action Required
By August 19, 2024: Billing team must ensure CPT code 97542 (wheelchair management) includes appropriate GP (physical therapy) or GO (occupational therapy) modifiers on both prior authorization requests and claims for Indiana Medicaid patients. Update billing system to require modifier match. Claims with mismatched modifiers will deny with EOB code 3001.