MedicaidCoverageMedium impact
BT2022103: IHCP clarifies customized wheelchair billing for members residing in a nursing facility
Indiana Medicaid (IHCP)·IN · PM&R (Physical Medicine & Rehab), Orthopedics·Claims & Billing
Effective date
Nov 17, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid clarified that only truly customized wheelchairs (uniquely constructed or substantially modified) for nursing facility residents can be billed to Medicaid using E1399 with prior authorization. Standard or custom-fitted wheelchairs must be billed directly to the nursing facility as they are included in the facility's per diem rate.
Action Required
Immediately: DME billing staff must review all wheelchair claims for nursing facility residents in Indiana. Use E1399 with prior authorization only for truly customized wheelchairs that meet the strict definition (uniquely constructed/substantially modified). For all other wheelchairs (custom-fitted, assembled from parts, or with standard features), bill the nursing facility directly instead of Medicaid. Update billing system to flag nursing facility wheelchair claims for manual review to prevent claim denials.