MedicaidReimbursementHigh impact
BT202432: CMS approves State Plan Amendment (23-0011) – NF and Hospice provider reimbursement impacts
Indiana Medicaid (IHCP)·IN · Palliative Care·Claims & Billing
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
Summary
CMS approved changes to Indiana Medicaid reimbursement for nursing facility and hospice providers, creating new add-on payments for specialized care (Alzheimer's/dementia and ventilator-dependent residents) that are now billed separately using specific revenue codes instead of being embedded in daily rates.
Action Required
Immediately: Nursing facility and hospice providers must begin using revenue code 193 for Alzheimer's/dementia special care unit residents ($12/day add-on) and revenue code 199 for ventilator-dependent residents ($80/day add-on) on UB-04 claims. These must be billed as additional detail lines alongside room-and-board codes. Resubmit all claims from July 1, 2023 forward that qualify for these add-ons but were not originally billed with the correct revenue codes. Mass adjustments will be processed for claims already submitted with correct codes.