Indiana Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Indiana, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Indiana billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Indiana billing guide: how Indiana pays for outpatient care
Indiana Medicaid runs through the Indiana Health Coverage Programs (IHCP), administered by the Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning, with Gainwell handling fee-for-service (FFS) claims. Most behavioral health services for Healthy Indiana Plan (HIP), Hoosier Healthwise and Hoosier Care Connect members are carved into managed care, so claims go to the member's managed care entity (Anthem, CareSource, Managed Health Services or UnitedHealthcare Community Plan; MDwise left on January 1, 2026).
IHCP FFS claims have a 180-day filing limit from the date of service, and managed care limits are set by each plan. Anthem Blue Cross and Blue Shield is the Blue Cross Blue Shield licensee named on Anthem's Indiana provider pages, and Medicare Part B is handled by WPS Government Health Administrators in Jurisdiction 8. HIP work requirements start January 1, 2027 for adults 19 to 64, with exemptions listed for substance use disorder, a serious mental health condition and drug or alcohol treatment.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Indiana Health Coverage Programs (IHCP), including the Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW), Hoosier Care Connect (HCC) and PathWays for Aging: Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP); IHCP provider site. | Provider enrollment |
| Medicare Part B | Wisconsin Physicians Service Government Health Administrators (WPS GHA) | CMS MAC page |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield (Indiana) | See the Blue Cross section below |
Indiana Medicaid and how to bill it
This Indiana billing guide starts with Medicaid, because it decides who pays and how you file.
Mostly managed care. IHCP lists five managed care entities: Anthem (HIP, HHW, HCC, PathWays for Aging), CareSource (HIP, HHW), Managed Health Services/MHS (HIP, HHW, HCC), UnitedHealthcare Community Plan of Indiana (HCC, PathWays) and Humana Healthy Horizons in Indiana (PathWays).
The IHCP Behavioral Health Services module (v4.6) says most behavioral health services are carved into HIP, Hoosier Care Connect and Hoosier Healthwise, so they go to the member's managed care entity (the module also mentions its behavioral health organization).
| Item | What to know |
|---|---|
| Agency | Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP); IHCP provider site |
| Claims or fiscal agent | Gainwell Technologies handles FFS claims (professional CMS-1500 claims: PO Box 50447, Indianapolis, IN 46250-0418; EDI payer ID 'IHCP'). Managed care claims go to the member's managed care entity. IHCP Provider Customer Assistance 800-457-4584. Source: IHCP Quick Reference Guide v14.1, 1 May 2026. |
| Provider enrollment | Official enrollment page |
| Manual or fee schedule | Official manual or fee schedule |
| Provider portal | Provider portal |
| Work requirement | FSSA's HIP work requirements page (modified October 23, 2026) says Indiana Medicaid will begin enforcing work requirements on January 1, 2027 for HIP members ages 19 to 64 who are not pregnant and not enrolled in or eligible for Medicare. Requirements apply to new applicants and to redeterminations initiated on or after January 1, 2027. |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Anthem Blue Cross and Blue Shield (Medicaid) | HIP, Hoosier Healthwise, Hoosier Care Connect and Indiana PathWays for Aging per the IHCP managed care page. |
| CareSource | HIP and Hoosier Healthwise per the IHCP managed care page. |
| Managed Health Services (MHS) | HIP, Hoosier Healthwise and Hoosier Care Connect. |
| UnitedHealthcare Community Plan of Indiana | Hoosier Care Connect and PathWays for Aging per the IHCP managed care page. |
| Humana Healthy Horizons in Indiana | PathWays for Aging only per the IHCP managed care page. |
Timely filing: the IHCP Claim Submission and Processing module (v8.5, published Feb. 24, 2026) states the FFS filing limit as 180 days after the date of service.
Medicare Part B in Indiana
For Medicare, this Indiana billing guide names your contractor and the current telehealth rules.
As of 2026-10-25, per CMS Telehealth FAQ (updated 10/8/26): Medicare telehealth flexibilities run through December 31, 2027, including audio-only at home.
| Item | What to know |
|---|---|
| Contractor | Wisconsin Physicians Service Government Health Administrators (WPS GHA) |
| Jurisdiction | Jurisdiction 8 (J8): Indiana and Michigan. |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Indiana
This part of the Indiana billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. Here is who holds the Blue license in Indiana.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield (Indiana) | Blue Cross Blue Shield Association licensee | Anthem's Indiana provider pages are published under the name 'Anthem Blue Cross and Blue Shield (Anthem)'. | Source |
Other private payers and EAPs in Indiana
The Indiana billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Indiana. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Aetna | National provider contact page lists 1-888-MD Aetna (632-3862) for indemnity and PPO-based plans. | Official page |
| Cigna / Evernorth Behavioral Health | Cigna provider contact page lists Evernorth Behavioral Health at 800.926.2273 and telephone transactions/precertification at 800.88Cigna; page is national, not Indiana-specific. | Official page |
| UnitedHealthcare / Optum Behavioral Health | UnitedHealthcare provider contact page lists Provider Services 877-842-3210; Optum Provider Express lists credentialing, contracting and network status at 877-614-0484. | Official page |
| Ambetter from MHS | Ambetter Indiana contact page lists a member line only (1-877-687-1182); no provider line or filing limit was found. | Official page |
Indiana billing guide: state law that changes billing
Use this section of the Indiana billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Indiana. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Indiana Department of Insurance (IDOI) report to the General Assembly under HEA 1092 cites IC 27-8-5-15.6, IC 27-8-5-15.8, IC 27-13-7-14.2 and IC 27-13-7-14.8 for mental health and substance use parity, and says IDOI enforces parity through market conduct examinations with authority to order curative measures. The report does not give the statutes' text. Source
Telehealth coverage and payment parity
IHCP's Telehealth and Virtual Services module (v6.1) says practitioners listed in IC 25-1-9.5-3.5 may provide telehealth within their Indiana licensure, and requires POS 02 or 10 with modifier 95 (audio and video) or 93 (audio-only) on professional telehealth claims. Citation: IC 25-1-9.5-3.5 (practitioner authority, per IHCP module); IHCP module PROMOD00048. Source
Prompt payment and timely filing
IDOI Bulletin 224 (Dec. 11, 2015) identifies IC 27-8-5.7 and IC 27-13-36.2 as Indiana's clean claims laws and says IDOI sets the annual interest rate for late clean-claim payment (1% for calendar year 2016 in that bulletin). Medicaid FFS filing limit is 180 days from the date of service per the IHCP claim module. Citation: IC 27-8-5.7; IC 27-13-36.2; IDOI Bulletin 224. Source
Practitioner scope: therapists and prescribers
IHCP's Behavioral Health Services module (Table 1) lists enrolled outpatient provider types: physicians including psychiatrists (type 31), HSPP (type 11, specialty 114), LCSW (618), LMHC (620), LMFT (619), LCAC (621), licensed psychologist (616), school psychologist (617), psychiatric APRN (type 09) and PA (type 10). Master's or doctoral graduates who are not licensed cannot enroll or bill directly. Source
Not legal advice. Confirm statute details with counsel.
Indiana billing guide: codes and rates
This Indiana billing guide lists only codes and rates confirmed on official pages.
These are the Indiana-specific codes, modifiers and rate items confirmed on official pages.
| Code or item | What to know |
|---|---|
| Outpatient behavioral health practitioner payment levels (FFS) | IHCP Behavioral Health Services module v4.6: practitioners other than physicians and HSPPs are paid 75% of the fee schedule amount; licensed psychologists and school psychologists were raised to 100% for dates of service on or after April 1, 2024 (January 1, 2024 for managed care); PAs and APRNs are set at 85%. Source |
| Modifiers HE and AH | Non-enrolled practitioners bill under an enrolled NPI with modifier HE (HE plus SA for APRNs); clinical psychologists use AH. Source |
| H2011 crisis intervention | Billed per 15 minutes, no prior authorization, face-to-face contact required (within one hour for imminent risk, four hours for a new at-risk symptom). Source |
| Telehealth POS and modifiers | Professional telehealth claims use POS 02 (other than patient's home) or POS 10 (patient's home) with modifier 95 (audio and video) or 93 (audio-only for designated services). Source |
| Psychiatric collaborative care G0568, G0569, G0570 | IHCP bulletin BT202630 (March 5, 2026, 2026 annual HCPCS update) lists these codes as noncovered. G0540 and G0554 were added to add-on code logic. Source |
Indiana billing guide: what changed, newest first
Check this Indiana billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-23 | FSSA's HIP work requirements page was modified; it states enforcement begins January 1, 2027 for new applicants and for redeterminations initiated on or after that date, with exemptions including substance use disorder and serious mental health condition. | Source |
| 2026-10-20 | The IHCP Behavioral Health Services module (v4.6) page shows a publication date of Oct. 20, 2026; policies effective as of Aug. 1, 2023. | Source |
| 2026-10-08 | CMS Telehealth FAQ updated: Medicare telehealth flexibilities through 12/31/2027; in-person requirement for mental health telehealth after 12/31/2027. | Source |
| 2026-07-06 | FSSA announced HIP work requirement implementation details: phase-in from January 1, 2027, ages 19 to 64, 80 hours a month, with a lookback for applicants. | Source |
| 2026-06-23 | IHCP bulletin BT2026108 announced HIP work requirements to providers and pointed to the FSSA partner toolkit. | Source |
| 2026-05-01 | IHCP Quick Reference Guide v14.1 issued with current MCE provider lines by program. | Source |
| 2026-03-05 | IHCP bulletin BT202630 covered the 2026 annual HCPCS update, including noncovered psychiatric collaborative care codes G0568 to G0570. | Source |
How do I bill mental health claims in Indiana?
These answers come from the same sources as the rest of this Indiana billing guide.
Indiana Medicaid runs through the Indiana Health Coverage Programs (IHCP), administered by the Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning, with Gainwell handling fee-for-service (FFS) claims. Most behavioral health services for Healthy Indiana Plan (HIP), Hoosier Healthwise and Hoosier Care Connect members are carved into managed care, so claims go to the member's managed care entity (Anthem, CareSource, Managed Health Services or UnitedHealthcare Community Plan; MDwise left on January 1, 2026). Start with the member's payer type: Medicaid plan, Medicare Part B, a Blue Cross licensee or another commercial plan.
Questions about billing in Indiana
How long do I have to file an Indiana Medicaid fee-for-service claim?
The IHCP claim module (v8.5, Feb. 24, 2026) states the filing limit as 180 days after the date of service. Managed care plans set their own limits, so check each plan's provider manual.
Do I bill Indiana Medicaid or the managed care plan for behavioral health?
For HIP, Hoosier Healthwise and Hoosier Care Connect, IHCP says most behavioral health services are carved into managed care, so bill the member's plan: Anthem, CareSource, MHS or UnitedHealthcare Community Plan. Medicaid Rehabilitation Option services and certain 1915(i) services stay FFS.
Which provider types can bill Indiana Medicaid for outpatient therapy?
IHCP enrolls psychiatrists as physicians (type 31) and lists HSPPs, LCSWs, LMHCs, LMFTs, LCACs, licensed psychologists and psychiatric APRNs as outpatient behavioral health providers. Unlicensed master's or doctoral graduates cannot enroll or bill directly. Non-enrolled practitioners can bill under an enrolled NPI with modifier HE.
When do Indiana Medicaid work requirements start?
FSSA says work requirements for Healthy Indiana Plan adults ages 19 to 64 start January 1, 2027. Members need 80 hours a month of qualifying activity unless exempt. Listed exemptions include substance use disorder treatment, medically frail status with a substance use disorder, and medically frail status with a serious mental health condition.
Does MCM South bill for practices in Indiana?
MCM South currently serves ten states; request a quote to ask about Indiana.
Sources for the Indiana billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- CMS Telehealth FAQ (updated 10/8/26), checked October 25, 2026
- FSSA HIP work requirements page, checked October 25, 2026
- FSSA HIP work requirements press release (July 6, 2026), checked October 25, 2026
- IHCP Claim Submission and Processing module v8.5, checked October 25, 2026
- IHCP Quick Reference Guide v14.1, checked October 25, 2026
- IHCP managed care health plans page, checked October 25, 2026
- IHCP Behavioral Health Services module v4.6, checked October 25, 2026
- IHCP Telehealth and Virtual Services module v6.1, checked October 25, 2026
- IHCP Healthy Indiana Plan module v5.1, checked October 25, 2026
- IHCP bulletin BT2026108, checked October 25, 2026
- IHCP bulletin BT202630, checked October 25, 2026
- IHCP bulletin BT202608, checked October 25, 2026
Related guides
Billing in Indiana? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Indiana.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.