Indiana Health Coverage Programs' October 22 coding bulletin and its original wheelchair-management modifier notice
An Indiana Medicaid coding notice gives OT practices a reason to reopen some old group-therapy billing problems. The October 22 bulletin pairs a December 1 modifier change with a time-limited route to correct affected fee-for-service authorizations and claims.
In brief
- Group therapy code 97150 will require GO for OT or GP for PT on fee-for-service authorization requests and claims.
- The change reaches dates of service from January 1, 2025.
- Providers have 180 days from the bulletin's publication to complete the specified revisions and resubmissions.
Match the authorization before resubmitting the claim
Starting December 1, Indiana will compare modifier use on 97150 claims with the authorization. A mismatch produces denial code 3001. The instructions cover professional and institutional-outpatient claims.
For PT/OT overlapping-code billing problems involving authorization requests submitted between January 1, 2025, and December 1, 2026, the bulletin directs providers to send Acentra Health a revision for 97150 only, with the appropriate modifier. Once approval is entered, claims can be resubmitted to Gainwell Technologies. Submissions beyond the usual 180-day filing limit need the bulletin's first page attached to both submissions.
A practical starting point is a list of unresolved 97150 claims with the original authorization beside each one. Record the modifier, service dates, denial reason, and revision status. That gives the billing team a way to identify cases that fit the notice without sending every old therapy denial through the same process.
Two table corrections have older roots
The same notice adds wheelchair-management code 97542 to the modifier-match table, correcting an omission dating to August 19, 2024. Indiana's July 2024 bulletin already explained that the modifier on the claim must agree with the authorization, for both fee-for-service and managed care. It also directed managed-care questions to the member's plan.
The state is removing swallowing-evaluation code 92610 from that table because prior authorization was never required when the code was allowed for PT and OT providers. That correction should not be read as a new coverage expansion.
Give the recovery work an owner
Practices can prepare their December claim templates while assigning someone to track the older cases. Save the notice with the revision records and calendar the recovery window from October 22, rather than from the December implementation date. The bulletin specifies a fee-for-service route for 97150; teams handling managed-care claims should confirm the applicable process with the plan.
A revised authorization is one step in resolving a claim. Keep the case open until the remittance shows how the resubmission was processed, then reconcile the result against the original denial.