MedicaidCoverageLow impact
BT202069: Correction made to lifetime cap in A&D and TBI waiver services
Indiana Medicaid (IHCP)·IN · PM&R (Physical Medicine & Rehab), Occupational Therapy, Physical Therapy·Specialty Services
Effective date
Feb 1, 2020
We identified it
Jun 19, 2026
Summary
Indiana corrected a typographical error in home modification lifetime caps for Aged & Disabled and Traumatic Brain Injury waivers. The lifetime limit is $20,000 with a maximum of $15,000 per single project for procedure code S5165 U7 NU.
Action Required
Immediately: Billing team must update system settings for HCPCS code S5165 U7 NU (home modifications - installation) to reflect corrected lifetime cap of $20,000 with single project limit of $15,000. Update authorization tracking to monitor cumulative spending against these limits for Indiana Medicaid A&D and TBI waiver patients.