Indiana FSSA Medicaid · October 24, 2026 · Primary source
BT202627: IHCP announces changes to applied behavior analysis (ABA) therapy services
Summary
IHCP Bulletin BT202627 (February 26, 2026) announces substantial changes to Indiana Medicaid ABA therapy coverage effective April 1, 2026. Key changes include restricting coverage exclusively to EPSDT-eligible members under age 21 (with a six-month transition for current adult recipients through September 30, 2026, after which ABA is no longer authorized or reimbursed for members 21 and older), a 6% rate reduction on all nongroup ABA services beginning April 1, 2026 and an additional 4% reduction on all ABA services beginning April 1, 2027, new group-size stratification modifiers for group ABA codes 97154, 97157, and 97158, a lifetime cap of 4,000 hours for comprehensive ABA therapy, new modifier requirements (UA for comprehensive ABA, U1 through U3 for rendering-provider credential type), caregiver coaching requirements, RBT supervision requirements, and telehealth restrictions for certain ABA services.
What this may mean
ABA therapy providers in Indiana face immediate revenue impact from the 6% rate reduction on April 1, 2026, across all nongroup procedure codes and a further 4% reduction in 2027 across both individual and group codes. Providers serving members age 21 and older must actively plan transitions before October 1, 2026, after which IHCP will not authorize or reimburse services for that population. The new modifier and lifetime-hours tracking requirements create billing compliance obligations that, if not implemented correctly, will result in claim denials or potential false-claims exposure for claims submitted without the required UA or group-size modifiers.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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