---
title: Anthem Indiana Medicaid ABA coverage (Hoosier Healthwise / HIP / HCC).
url: "https://carelu.com/payers/anthem-indiana-medicaid"
markdown_url: "https://carelu.com/payers/anthem-indiana-medicaid.md"
state: IN (Indiana)
payer: Anthem BCBS Indiana (Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: Indiana Medicaid (IHCP)
description: "How Anthem administers ABA for Indiana Medicaid (Hoosier Healthwise, HIP, Hoosier Care Connect) — its UM guideline restating IHCP criteria, the Availity/ICR submission path, and the documentation package that gets requests through."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Anthem Indiana Medicaid ABA coverage (Hoosier Healthwise / HIP / HCC).

_Payer Guide · Anthem (IN Medicaid) · Last updated October 2026 · 25 primary sources_

> IHCP criteria restated in Anthem's UM guideline; Availity/ICR submission, F84.0 + daily schedule.

Anthem Blue Cross and Blue Shield serves Indiana Medicaid members across Hoosier Healthwise, HIP, and Hoosier Care Connect, and administers ABA under its own UM guideline — which is an explicit restatement of the IHCP rules (405 IAC 5-22-12 and the state bulletins). Clinically you're dealing with state policy; operationally you're dealing with Anthem's documentation package and the Availity/Interactive Care Reviewer pipeline. One caution: Anthem's published guideline predates the April 2026 state changes, so where they differ, the state rules control.

This plan administers the **Indiana Medicaid (IHCP)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Indiana Medicaid (IHCP) guide](https://carelu.com/payers/indiana-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — PA with autism dx (F84.0), testing results, intake assessment, treatment plan, and daily schedule [1][2]
- **Prior auth for treatment** _(plan-dependent)_: Required — 6-month maximum per IHCP policy and Anthem's guideline (Indiana's 1-year authorization-validity statute is unreconciled); continuation needs updated plan, testing within 2 months of treatment start, progress per goal [1][2][4][8][26]
  - Ask the plan: IHCP's ABA rule caps each PA request at six months (BH module; BT2026136, 8/18/2026, still calls it the "standard six-month authorization period"), while IC 27-1-37.5-26(b), which reaches Medicaid managed care, says an authorization "shall be valid for at least one (1) year." No IHCP bulletin or MCE notice reconciles the two. Ask the MCE's UM team what authorization span it is issuing for ABA.
- **Autism diagnosis required?**: Yes — ASD coded F84.0, with testing results (Anthem package) [1]

## At a glance

- **Plan type:** IHCP MCE (Hoosier Healthwise, HIP, Hoosier Care Connect)
- **Clinical rules:** Anthem UM guideline restating IHCP criteria (AINPEC-3345-21)
- **Prior auth:** Required for all ABA; max 6-month authorizations per IHCP (1-year statute unreconciled — ask Anthem)
- **Hours:** Up to 40 hrs/wk; beyond needs additional PA (mirrors IHCP)
- **Submission:** Availity / Interactive Care Reviewer; IHCP universal PA form by fax
- **Caution:** Guideline last reviewed 2021 — 2026 state changes control
- **Diagnosis recency:** State rule: CDE >1 year old needs an updated statement of need

## The initial request package

Anthem's stated initial-request requirements are concrete: the PA form, the autism diagnosis coded F84.0, applicable testing results, an intake assessment covering level of functioning, severity, and social/life skills, the treatment plan, and — the one teams miss — the child's daily schedule. Continuation requests need a new PA with an updated treatment plan, developmental testing within 2 months of treatment start, and progress-to-date per goal. Submissions run through Availity's Interactive Care Reviewer, with fax (using the IHCP universal PA form) and phone as alternatives. [1][2]

## What intake should watch

Members whose care runs through an ACO, PMG, or IPA-contracted group must follow that group's authorization and claims rules rather than Anthem's direct process — worth checking during verification. And because Anthem's guideline hasn't been re-issued since 2021, the 2026 IHCP changes (EPSDT-only, the under-21 cutoff, the 4,000-hour lifetime allocation, mandatory caregiver coaching, and the telehealth restrictions) apply through state policy even though the plan document doesn't mention them. [3]

## Is Anthem's ABA network open to new providers?

Not to new agencies, while Indiana's ABA enrollment moratorium lasts. IHCP Bulletin BT202692 (6/4/2026): a CMS-approved moratorium, effective June 6, 2026 for an initial six months and extendable in six-month increments, "will prevent enrollment for brand-new ABA group enrollments as well as changes of ownership for existing ABA therapy agencies"; individual rendering-provider (RBT/BCaBA/BCBA) enrollment is not affected. That reaches Anthem's network because federal rule requires the state to "screen and enroll" every network provider of its managed-care plans, and a plan must drop a network provider the state cannot enroll. Accredited agencies can ask IHCP for an access exception at OMPPProviderRelations@fssa.in.gov. Whether Anthem is adding already-enrolled ABA agencies to its panel is a contracting question — the plan publishes no open/closed statement for ABA. [9][10]

## Can an out-of-state BCBA treat an Indiana member, including by telehealth?

Indiana licenses the practice: an individual may not “practice applied behavior analysis” unless the individual “holds a license issued under this chapter” (IC 25-8.5-3-6(a)); the PLA takes reciprocity applications ($75 for an LBA). Indiana’s telehealth law (IC 25-1-9.5) defines a telehealth “practitioner” as someone holding “an unlimited license to practice” in Indiana and lists “a behavior analyst licensed under IC 25-8.5,” so plan on an Indiana license before treating a child located in Indiana remotely. [13][14][15][16][17]

Indiana Medicaid enrolls some out-of-state providers (405 IAC 5-5), but the IHCP Provider Enrollment Type and Specialty Matrix “indicates which provider types and specialties are ineligible for out-of-state enrollment,” and “In general, all out-of-state services rendered to IHCP members require prior authorization (PA)” on top of the ABA PA. That extra out-of-state PA is waived for “Telehealth services if providers have the subtype ‘Telemedicine’ attached to their enrollment,” and for providers granted “in-state” status for service locations in designated border-area counties (Cook County, Illinois, is one). Check the Matrix for the ABA specialties (615, 624, 625) before applying. [13][14][15][16][17]

Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Anthem’s network has to be enrolled with the IHCP as well. [13][14][15][16][17]

## Anthem Indiana Medicaid ABA claims: filing deadline and payment clock

Filing deadline: Anthem’s 2026 IHCP Works claims session sets 90 calendar days from the last date of service for a primary claim and 90 calendar days from the primary payer’s remittance advice for a secondary claim; claims must pass front-end edits to count as received. Its Carelon behavioral health session gives the same 90 days for new claims and for third-party-liability claims (from the date of the third party’s notice), 60 calendar days from the EOB date for corrected claims and for disputes, and 60 days from the dispute response for an appeal. Corrections go in as replacement claims (frequency code 7); voids (frequency code 8) within 60 calendar days. Anthem waives timely filing for retroactive eligibility, authorization updates, COB errors and its own processing issues, with documentation. [21][22][23][24]

Payment clock: “Anthem will finalize a clean electronic claim within 21 calendar days from the date the claim is received. Clean paper claims are paid within 30 calendar days,” with interest on clean claims not decided in those windows. The federal floor every Indiana MCE contract must carry is 42 CFR 447.46: pay 90% of clean practitioner claims within 30 days of receipt and 99% within 90 days, unless the plan and provider agree an alternative schedule in the contract. [21][22][23][24]

Taxonomy: Anthem’s 2026 Carelon behavioral health session encourages billing providers “to always include the billing taxonomy code that matches the taxonomy code registered with the state” to pass the one-to-one NPI match; the rendering provider in box 24J must be linked with IHCP to the service location in box 33, and Anthem does not use box 32 for that match. [21][22][23][24]

## Reauthorization: what a continuation PA must contain (graphs required)

Follows the Indiana Medicaid rule — IHCP states that its ABA “documentation requirements outlined in IHCP policy are applicable to both FFS and managed care” (BT202562). Reauthorization: each ABA PA runs up to six months, and continuing past it takes a new PA request. It is approved when the member still meets ABA criteria and the treatment plan is resubmitted with measurable progress to date on each goal, a revised timeline for each goal based on the initial and interim assessments, clinically significant progress in social, communication and language skills, adaptive functioning and behavior, and updates to hours, schedule, parent training and school-transition plans. Continuing members need no new comprehensive diagnostic evaluation but do need an updated behavior assessment and treatment plan (BT202562), and the behavior assessment’s “complete scoring report, including outcome measure scores and graphs, must be submitted with prior authorization requests.” Graphs are therefore required — of the standardized assessment results — and discharge follows when measurable functional improvement is not documented or progress stalls across successive authorization periods. [4][5][3]

Code set (IHCP rule): ABA bills under CPT 97151–97158, 0362T and 0373T with IHCP’s credential, group-size and UA modifiers (BT202627); BT202562 adds that each MCE sets its own billing and reimbursement requirements, so confirm any plan-specific edits. [4][5][3]

## Intake gates

The questions that decide whether a family can start with Anthem BCBS Indiana (Medicaid), and what they have to bring.

- **Age limit**: Follows the Indiana Medicaid rule: ABA is covered for members 20 years of age and younger. Effective April 1, 2026 coverage runs exclusively through EPSDT, and for dates of service on or after October 1, 2026 IHCP no longer authorizes or reimburses ABA for members 21 and older — a state policy that binds every MCE. [4][3][5]
- **Diagnosis recency**: Follows the Indiana Medicaid rule: a CDE more than one year old requires an updated statement of need, which must include a referral from an appropriate referring practitioner and an up-to-date behavior assessment completed by the ABA provider. Members continuing current services need no new CDE but do need an updated behavior assessment and treatment plan. A behavior assessment completed within the previous six months should be obtained from the original provider rather than repeated. IHCP states these documentation requirements apply to managed care as well as fee-for-service. BT2026160 (9/29/2026) since narrowed when that paperwork is due: “statement of need” and “referral” now mean the same thing, and one is required only at onset of ABA if the CDE is more than a year old, at reauthorization when an active member’s CDE crosses one year, or with a new PA after a six-month gap in ABA services — not with every reauthorization or annually — while reassessment and an updated treatment plan are still due at least every six months. [5][4][11]
- **Who may diagnose**: Follows the Indiana Medicaid rule: the CDE must be performed by a provider with specialized training in the current DSM autism criteria who is a doctoral-level licensed clinical psychologist endorsed as an HSPP, a licensed physician, a licensed APRN, or a licensed physician assistant. Anthem's own UM guideline asks for the autism diagnosis coded F84.0 with applicable testing results rather than restating the credential list — and because that guideline was last reviewed in 2021, the state list controls where they differ. [5][1]
- **Diagnostic tools required**: Two requirements stack. The state's behavior assessment must include three core standardized instruments — the Vineland Comprehensive Parent Interview Form with the Maladaptive Behavior domain, the BASC Parenting Relationship Questionnaire, and an age-appropriate objective direct skills assessment — with the complete scoring report, outcome scores and graphs submitted with the PA. Anthem's own package then asks for “applicable testing results” plus an intake assessment covering level of functioning, severity and social/life skills, and for continuation, developmental testing within 2 months of treatment start. Note the currency switch: only BASC-4 satisfies the state requirement after October 1, 2026. [4][1][6]
- **Referral required?**: Follows the Indiana Medicaid rule: a physician must make a treatment referral recommending ABA therapy, and the CDE’s own required components include a physician’s referral for autism-specific services. Under BT2026160 (9/29/2026) the referral/statement of need must come from an HSPP-endorsed doctoral psychologist, a licensed physician, a licensed APRN or a licensed physician assistant — a BCaBA, BCBA, PT, SLP or OT cannot complete it. Prior authorization is required on top of the referral for every ABA service, through this plan rather than through Acentra Health. [4][5][11]
- **Telehealth**: Follows the Indiana Medicaid rule, with no ABA telehealth policy of the plan’s own. Effective April 1, 2026, IHCP no longer allows 97151, 97152, 97153, 97154 or 0373T to be billed with telehealth modifier 95, so the assessment, reassessments and all direct and group treatment are in person. Only 97155 and 97156 remain telehealth-eligible; IHCP’s provider reference module adds that RBTs and BCaBAs may not deliver any ABA service via telehealth, that remote 97155 is payable only when an HSPP, BCBA or BCBA-D supervises an RBT who is delivering 97153 in person, and that audio-only ABA is never reimbursable (modifier 95 plus U3). IHCP Bulletin BT202662 (4/28/2026) adds that supervision “may be rendered via synchronous telehealth and billed using modifier 95” but “is intended to supplement, not replace, the majority of in-person services.” The module is written for fee-for-service and IHCP says MCEs set their own billing requirements, so confirm with the plan before billing remote 97155 or 97156. [3][4][5][12]
- **Prior-auth decision time**: Indiana law sets the binding clock, and it is far faster than the federal one. Since July 1, 2025, IC 27-1-37.5-23 requires a utilization review entity to answer an urgent PA request “not later than twenty-four (24) hours after receiving the request” and every other request “not later than forty-eight (48) hours,” with “weekends and state and federal legal holidays” excluded from both clocks; the chapter's “health plan” expressly includes “the Medicaid risk based managed care program” (IC 27-1-37.5-5), and IC 27-1-37.5-28 makes a missed deadline an automatic approval: the service “shall be automatically deemed authorized.” The federal managed-care floor, 42 CFR 438.210(d), is only a ceiling for states (7 calendar days standard for rating periods starting on or after 1/1/2026, extendable 14 days; 72 hours expedited), so the stricter Indiana clock wins. Anthem's own Indiana Medicaid Provider Manual (INBCBS-CD-PM-070775-24, April 2025) still prints the pre-statute timelines — non-urgent pre-service “within 5 business days (not including weekends and state-approved holidays) from receipt of the request,” urgent pre-service and concurrent reviews within 48 hours — so hold Anthem to the statute, not the manual. Neither the manual nor Anthem's Indiana Medicaid ABA guidelines publish a reauthorization submission lead time. [29][27][30][23][31]
- **Other insurance (who pays first)**: Anthem pays last. Its Indiana Medicaid manual: “Anthem is the payer of last resort per Federal and State guidelines,” and a COB claim must carry the other payer's remittance advice/EOP or a letter explaining the denial — paper claims without one are mailed back, electronic ones denied — and must reach Anthem “within 90 days from the date on the other program’s RA/EOP or letter of denial of coverage.” Anthem pays “up to the IHCP allowed amount” and “adjudicates COB claims in alignment with the IHCP Third Party Liability Module” — the module that refuses claims the primary denied as out-of-network, so be in the commercial plan's network. If commercial coverage turns up after Anthem paid, Anthem recovers from the other carrier rather than from you. Get this plan's ABA PA even when it is secondary: the IHCP Prior Authorization module says that when the member has primary coverage, the provider “must follow the primary insurer's requirements for obtaining PA and must also obtain PA from the appropriate IHCP PA contractor (based on the program assignment of the member) to receive payment from the IHCP for the balance of charges not paid by the primary insurance.” The Anthem manual adds nothing of its own on PA-when-secondary beyond Medicare. TRICARE is not a problem here: 32 CFR 199.8 excludes Medicaid from the “double coverage plans” TRICARE pays after, so for a child with both, TRICARE pays before Medicaid. [23][32][33][34]

## Delivery and billing rules

Coverage decides whether Anthem BCBS Indiana (Medicaid) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the Indiana Medicaid rule: ABA performed by a BCaBA or credentialed RBT must be under the direct supervision of a BCBA, BCBA-D or HSPP, and since April 1, 2026 at least 1 hour of BCBA (or IHCP-approved qualifying clinician) supervision is required per 8 hours of technician-delivered therapy. Behavior assessments may only be performed by a psychologist, BCBA-D or master's-level BCBA. IHCP states that its ABA documentation requirements apply to both fee-for-service and managed care, and this plan publishes no supervision standard of its own. BT202662 (4/28/2026) defines how the floor is measured: monthly, per member (“not aggregated across technicians or across Medicaid members”), proportionally when a member gets fewer than eight technician hours in the month, and counting both billable 97155 and documented nonbillable case supervision (fidelity checks, session-note review) — but not administrative supervision such as scheduling or staff meetings. Shortfalls are subject to claim audit, postpayment review and recoupment. [4][3][5][12]
- **Daily limits / MUEs**: Follows the Indiana Medicaid limits: up to 40 hours per week may be requested with anything beyond that needing an additional PA; IHCP policy limits each ABA PA request to six months; and since April 1, 2026 comprehensive ABA (16+ hours/week, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation per member, with 97155 and 97156 excluded and targeted ABA (≤15 hours/week) exempt. At the state level IHCP applies the Medicaid NCCI MUEs to fee-for-service professional claims per member, per rendering provider, per date of service (CMS Q4 2026 table: 97153 at 32 units, 97155 at 24, 97151 at 32, 97156 at 16); the IHCP NCCI module leaves managed care claims to each MCE, so confirm the plan’s own daily edits. Open question for managed care: IC 27-1-37.5-26(b), in force since July 1, 2025 and reaching Medicaid risk-based managed care through IC 27-1-37.5-5(a)(3), says an authorization "shall be valid for at least one (1) year after the date the health care provider receives the authorization," and CareSource's July 2025 IHCP Works deck lists "Approved Authorization — Valid for 365 calendar days." But IHCP Bulletin BT2026136 (8/18/2026), addressed to the MCOs and the FFS PA-UM contractor alike, still describes ABA as running on a "standard six-month authorization period." No IHCP bulletin or MCE notice we could find reconciles the two, so ask the MCE which span it is issuing before you plan a reauthorization calendar. [19][20][4][3][8][26][27][28]
- **Session-note signature**: Follows the Indiana Medicaid rule; the plan publishes no session-note rule of its own. IHCP’s ABA documentation requirements require "session notes, which must be signed by the rendering practitioner," each including the date, time, location and duration of services and the session-specific targeted skills and the member’s response to the treatment plan goals, producible within 72 hours of a request; the behavior assessment and treatment plan must each be signed by the lead analyst and the parent or guardian. IHCP states that "documentation requirements outlined in IHCP policy are applicable to both FFS and managed care." No signing deadline is published. [4][5]
- **Place of service**: Follows the Indiana Medicaid rule: the treatment plan must be built around the member's school attendance (including homeschooling) and other daily activities, while services focusing solely on recreational or educational outcomes are not covered, and neither are services duplicative of an IEP that address the same goals using the same techniques as the treatment plan. [4]
- **Bill as provider**: Follows the Indiana Medicaid rule: ABA rendered by a BCaBA or RBT must be billed under the NPI of an IHCP-enrolled ABA therapist or school corporation, on a professional claim. Since July 1, 2025 the rendering practitioner must be enrolled under ABA specialty 615, 624 or 625, and since April 1, 2025 the rendering NPI must align with the credential-level modifier (U1 RBT / U2 BCaBA / U3 BCBA-HSPP). Plan-level claim formatting may still differ — MCEs publish their own billing requirements. [4][3]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published by Indiana Medicaid or by this plan. IHCP is explicit that within managed care “individual managed care entities (MCEs) establish and publish their own billing and reimbursement requirements,” so unlike the clinical criteria, code-pair rules are not inherited from the state by default. The IHCP rule this plan may or may not mirror: BT202662 (4/28/2026) says “CPT code 97155 may be billed concurrently only with CPT codes 97153 and 97154,” and only when the analyst is actively directing the technician through a modified protocol. [5][12]
  - Ask the plan: The MCE directly — ask whether 97155 pays alongside 97153 for the same clock time, and request the plan's billing and reimbursement requirements in writing.

## What intake should collect for Anthem BCBS Indiana (Medicaid)

- **Program + delivery system:** Hoosier Healthwise vs. HIP vs. Hoosier Care Connect, and whether an ACO/PMG/IPA controls the auth path.
- **F84.0 diagnosis + testing:** The diagnosis code, evaluation, and testing results Anthem's package requires.
- **Daily schedule:** Anthem explicitly asks for it — capture school hours and other therapies at intake.
- **Age + prior ABA hours:** State rules add the under-21 cutoff and lifetime-allocation questions.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Anthem BCBS Indiana (Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 00709 — pVerify's own table flags "00709 ANTHEM BCBS INDIANA" as Eligibility=No / Claim=No (inactive) — the plan's own row, but no eligibility check can run on it. Eligibility runs under eligibilityPayer (BCBS of Indiana) instead.
- **Payer ID (Availity):** ANTHEM - IN — Same 2012-vintage Availity list staleness finding as every ID below — confirm against a current Availity export.
- **Eligibility payer:** BCBS of Indiana
- **Eligibility payer ID (pVerify):** 00034 — pVerify 00034 "BCBS of Indiana" — a completed eligibility check ran under 00034 with the prefixed member ID (cited in sources).
- **Member ID prefix:** Required: include the prefix exactly as printed on the card — The card's 3-letter alpha prefix goes in front of the member ID (e.g. YRH + the digits) — checks without it fail, checks with it verify (cited in sources).
- **Behavioral health administrator:** none — No Anthem Indiana Medicaid document reviewed states or disclaims a BH carve-out for ABA specifically — inferred "none" from the UM guideline describing direct PA/claims handling.
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U2, U3, UA (if comprehensive) |
| 97152 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, UA (if comprehensive) |
| 97153 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, U2, U3, UA (if comprehensive) |
| 97154 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, U4/U6/U8 (group size, required), UA (if comprehensive) |
| 97155 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3 |
| 97156 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3 |
| 97157 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3, U4/U6/U8 (group size, required), UA (if comprehensive) |
| 97158 | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U2, U3, U4/U6/U8 (group size, required), UA (if comprehensive) |
| 0362T | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | Not restricted by BT202627's 4/1/2026 telehealth change; no code-specific POS/modifier detail published for telehealth delivery of this code otherwise. | U1, UA (if comprehensive) |
| 0373T | Yes | Required — all ABA services (each PA ≤6 months) | No per-code daily/weekly unit cap published; PA-approved up to 40 hrs/week overall. Comprehensive ABA (16+ hrs/wk, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation — 97155 and 97156 are excluded from that allocation. per PA-approved weekly intensity; separate lifetime allocation for comprehensive ABA (per member, not per code) | — | No — modifier 95 (synchronous telemedicine) may not be billed with this code for DOS on/after 4/1/2026 (BT202627). | U1, UA (if comprehensive) |

Code notes:

- **97151:** Behavior identification assessment by professional, each 15 minutes. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97152:** Behavior identification assessment by technician, each 15 minutes. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97153:** Adaptive behavior treatment by technician; U2/U3 (BCaBA/BCBA) tiers newly allowable for this code effective 4/1/2026 (previously RBT/U1-only). Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97154:** Group ABA treatment by technician — group-size modifier required; no individual/non-group rate exists for this code. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97155:** Adaptive behavior treatment by professional using an established plan. May be billed concurrently with technician-delivered 97153 when the QHP directs a present technician. Excluded from the 4,000-hour comprehensive-ABA lifetime allocation. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97156:** Adaptive behavior treatment by professional with family. Excluded from the 4,000-hour comprehensive-ABA lifetime allocation. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **97157, 97158:** Group-only code — no individual/non-group rate exists. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **0362T:** Behavior identification supporting assessment for destructive behavior, technician face-to-face time. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.
- **0373T:** Adaptive behavior treatment with protocol modification for destructive behavior, technician face-to-face time. Verify via: Anthem Indiana Medicaid provider services / Availity Interactive Care Reviewer — this plan's own published materials don't restate per-code unit caps or modifier tables; the statewide IHCP pattern is applied here as inferred.

### Medicaid rates

Source: IHCP Bulletin BT202627 (Feb 26, 2026), Tables 1-3 — state fee-schedule maximum. MCE-contracted rates are negotiated separately per plan and not independently published; this is the benchmark cited in every Indiana Medicaid ABA guide. Effective 2026-04-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $20.56 (U2, BCaBA) / $25.97 (U3, BCBA/BCBA-D/HSPP/physician) | 15min | U2: $20.56 (DOS ≥4/1/2026) → $19.74 (DOS ≥4/1/2027); U3: $25.97 (DOS ≥4/1/2026) → $24.93 (DOS ≥4/1/2027) |
| 97152 | $16.04 (U1, RBT) | 15min | U1: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027) |
| 97153 | $16.04 (U1/U2/U3 — uniform across all three practitioner tiers since 4/1/2026) | 15min | U1: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027); pre-4/1/2026 was $17.06 (U1 only — U2/U3 not allowable for 97153 before that date); U2: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027) — N/A before 4/1/2026; U3: $16.04 (DOS ≥4/1/2026) → $15.39 (DOS ≥4/1/2027) — N/A before 4/1/2026 |
| 97154 | Group-only (no individual/non-group rate published) — $9.21 (U1+U4, group of 2), DOS ≥4/1/2026 | 15min | U1+U4 (group of 2): $9.21 (DOS ≥4/1/2026) → $8.84 (DOS ≥4/1/2027); pre-4/1/2026 flat rate (any group size) was $4.87; U1+U6 (group of 3): $6.14 (DOS ≥4/1/2026) → $5.90 (DOS ≥4/1/2027); U1+U8 (group of 4-8): $4.61 (DOS ≥4/1/2026) → $4.43 (DOS ≥4/1/2027) |
| 97155 | $20.54 (U2, BCaBA) / $25.97 (U3, BCBA) | 15min | U2: $20.54 (DOS ≥4/1/2026) → $19.72 (DOS ≥4/1/2027); U3: $25.97 (DOS ≥4/1/2026) → $24.93 (DOS ≥4/1/2027) |
| 97156 | $20.56 (U2, BCaBA) / $26.54 (U3, BCBA) | 15min | U2: $20.56 (DOS ≥4/1/2026) → $19.74 (DOS ≥4/1/2027); U3: $26.54 (DOS ≥4/1/2026) → $25.47 (DOS ≥4/1/2027) |
| 97157 | Group-only — $11.82 (U2+U4, group of 2), DOS ≥4/1/2026 | 15min | U2+U4 (group of 2): $11.82 → $11.35 (4/1/2027); pre-4/1/2026 flat rate (any size) was $6.25 (U2); U2+U6 (group of 3): $7.88 → $7.57 (4/1/2027); U2+U8 (group of 4-8): $5.91 → $5.68 (4/1/2027); U3+U4 (group of 2): $14.93 → $14.33 (4/1/2027); pre-4/1/2026 flat rate (any size) was $7.89 (U3); U3+U6 (group of 3): $9.95 → $9.56 (4/1/2027); U3+U8 (group of 4-8): $7.46 → $7.16 (4/1/2027) |
| 97158 | Group-only — $11.82 (U2+U4, group of 2), DOS ≥4/1/2026 (identical rate structure to 97157) | 15min | U2+U4 (group of 2): $11.82 → $11.35 (4/1/2027); pre-4/1/2026 flat rate (any size) was $6.25 (U2); U2+U6 (group of 3): $7.88 → $7.57 (4/1/2027); U2+U8 (group of 4-8): $5.91 → $5.68 (4/1/2027); U3+U4 (group of 2): $14.93 → $14.33 (4/1/2027); pre-4/1/2026 flat rate (any size) was $7.89 (U3); U3+U6 (group of 3): $9.95 → $9.56 (4/1/2027); U3+U8 (group of 4-8): $7.46 → $7.16 (4/1/2027) |
| 0362T | $26.83 (U1) | 15min | U1: $26.83 (DOS ≥4/1/2026) → $25.75 (DOS ≥4/1/2027) |
| 0373T | $26.83 (U1) | 15min | U1: $26.83 (DOS ≥4/1/2026) → $25.75 (DOS ≥4/1/2027) |

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** Varies by line of business — HIP: 844-533-1995 / Hoosier Care Connect: 844-284-1798 / Hoosier Healthwise: 866-408-6132 / PathWays: 833-569-4739 (Anthem Indiana Medicaid Provider Services)
- **Portal:** [Availity Essentials](https://Availity.com)
- **Fax:** Physical Health (Inpatient & Outpatient): 866-406-2803 / Behavioral Health Inpatient: 877-434-7578 / Behavioral Health Outpatient: 866-877-5229

Questions to ask on a verification call:

- Which of the four Anthem Indiana Medicaid lines of business (HIP, Hoosier Healthwise, Hoosier Care Connect, PathWays) is the member enrolled in? Provider Services routes to a different phone number for each.
- Does Availity support real-time (interactive) 270/271 for this member's plan, or only batch?
- What are the per-code unit caps, POS, and modifier requirements for this member's ABA authorization? (Anthem's UM guideline doesn't restate IHCP's statewide code-level table.)
- Please confirm the member ID exactly as printed on the card, including the three-letter prefix.

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://providers.anthem.com/docs/gpp/IN_CAID_ABAGuidelines.pdf (accessed 2026-07-23)
- https://pverify.com/payer-list/ (accessed 2026-10-13)
- https://www.in.gov/medicaid/providers/files/270-271-ihcp-companion-guide.pdf (accessed 2026-07-23)
- https://provider.indianamedicaid.com/ihcp/Publications/providerCodes/Behavioral_Health_Services_Codes.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/modules/behavioral-health-services.pdf (accessed 2026-07-23)
- https://www.in.gov/medicaid/providers/files/quick-reference.pdf (accessed 2026-07-23)
- https://providers.anthem.com/docs/gpp/IN_CAID_ProviderManual.pdf (accessed 2026-10-14)

## Common questions

### Does Anthem Indiana Medicaid cover ABA therapy?

Yes — under Anthem's UM guideline, which restates IHCP criteria: all ABA prior-authorized, 6-month max authorizations (Indiana's IC 27-1-37.5-26 says managed-care authorizations are valid at least a year, and nothing yet reconciles the two), up to 40 hours/week requestable, members 20 and younger.

### What does Anthem require for an ABA prior authorization?

The PA form, F84.0 diagnosis, testing results, an intake assessment (functioning, severity, social/life skills), the treatment plan, and the child's daily schedule — via Availity's Interactive Care Reviewer, fax, or phone.

### Do the 2026 Indiana ABA changes apply to Anthem members?

Yes — EPSDT-only coverage, the under-21 cutoff, the 4,000-hour lifetime allocation, and telehealth restrictions are state policy that binds every MCE, even though Anthem's published guideline predates them.

### Is Anthem accepting new ABA providers?

Not new agencies while Indiana's ABA enrollment moratorium lasts (effective June 6, 2026, renewable six months at a time): MCE network providers must be IHCP-enrolled, and the moratorium blocks new ABA group enrollments and changes of ownership. Existing IHCP-enrolled agencies should ask Anthem provider contracting about panel openings.

### What happens if a family switches ABA providers while on Anthem?

Anthem publishes no rule on transferring an open ABA authorization, so expect the new agency to submit its own PA and confirm with Anthem UM whether the old one must be closed first. Under IHCP documentation policy, which applies to managed care, a new provider is expected to obtain a behavior assessment completed within the last six months from the original provider instead of re-testing, and the member's 4,000-hour lifetime comprehensive-ABA allocation carries over.

### Can an out-of-state BCBA treat Anthem Medicaid members in Indiana, including by telehealth?

Indiana requires an Indiana license (IC 25-8.5-3-6), and its telehealth law counts only Indiana-licensed behavior analysts as practitioners. The IHCP enrolls some out-of-state providers, but out-of-state services generally need extra PA and some specialties are ineligible; check the Enrollment Matrix.

### Does Anthem (Indiana Medicaid) authorize ABA retroactively?

We have not verified Anthem’s rule. The IHCP’s retroactive-PA list is written for fee-for-service; for managed care members the IHCP Prior Authorization module sends providers to the MCE’s own manual. Ask Anthem UM before treating without an approved PA.

### Do we bill this plan for ABA written into a child’s IEP?

No. Indiana carves school-based Medicaid services out of managed care: the IHCP School Corporation Services module (Sept. 29, 2026) says school corporations “must not submit claims for these services to the student’s managed care entity (MCE)” and bill fee-for-service (Gainwell) instead, with modifier TM on every code and the education plan serving as prior authorization. ABA your agency delivers outside the school program still goes through the plan.

### What is Anthem Indiana Medicaid’s timely filing limit for ABA claims?

90 calendar days from the date of service; secondary claims 90 days from the primary payer’s remittance advice; corrected claims and disputes 60 days from the EOB. Anthem finalizes clean electronic claims within 21 calendar days and pays clean paper claims within 30.

### Does Anthem Indiana Medicaid require graphs for an ABA reauthorization?

Yes — IHCP’s ABA documentation rules apply to managed care: the behavior assessment’s complete scoring report, including outcome scores and graphs, goes with every PA request, along with an updated treatment plan showing measurable progress on each goal.

## Primary sources

1. [Anthem — Indiana Medicaid ABA UM Guideline](https://providers.anthem.com/docs/gpp/IN_CAID_ABAGuidelines.pdf)
2. [Anthem — Prior Authorization 201 (IHCP Works 2022)](https://www.in.gov/medicaid/providers/files/IHCP-Works-2022-Anthem-Prior-Authorization-201.pdf)
3. [IHCP Bulletin BT202627 — ABA policy updates](https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf)
4. [IHCP — Behavioral Health Services module (PROMOD00039, ABA section)](https://www.in.gov/medicaid/providers/files/modules/behavioral-health-services.pdf)
5. [IHCP Bulletin BT202562 — ABA documentation requirements (5/2025)](https://www.in.gov/medicaid/providers/files/bulletins/BT202562.pdf)
6. [IHCP Bulletin BT2026123 — BASC-3 PRQ to BASC-4 transition (7/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT2026123.pdf)
7. [IHCP Bulletin BT202519 — ABA enrollment FAQ](https://www.in.gov/medicaid/providers/files/bulletins/BT202519.pdf)
8. [IHCP Bulletin BT2026136 — Minimum caregiver coaching/training requirements for ABA clarified (8/18/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT2026136.pdf)
9. [IHCP Bulletin BT202692 — ABA agency provider enrollment moratorium (6/4/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT202692.pdf)
10. [42 CFR 438.602 — State screening and enrollment of MCO network providers (eCFR)](https://www.ecfr.gov/current/title-42/section-438.602)
11. [IHCP Bulletin BT2026160 — ABA statement of need and referral requirements clarified (9/29/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT2026160.pdf)
12. [IHCP Bulletin BT202662 — Additional ABA guidance: supervision, caregiver coaching, UA modifier (4/28/2026)](https://www.in.gov/medicaid/providers/files/bulletins/BT202662.pdf)
13. [Ind. Code § 25-8.5-3-6 — license required to practice applied behavior analysis](https://codes.findlaw.com/in/title-25-professions-and-occupations/in-code-sect-25-8-5-3-6/)
14. [Indiana PLA — Telehealth (IC 25-1-9.5) definitions](https://www.in.gov/pla/resources/telehealth-home)
15. [Indiana PLA — Behavior Analyst licensing information (fees incl. reciprocity application)](https://www.in.gov/pla/professions/behavior-analyst/behavior-analyst-licensing-information)
16. [IHCP — Out-of-State Providers module (PROMOD00011, published May 29, 2026)](https://www.in.gov/medicaid/providers/files/modules/out-of-state-providers.pdf)
17. [eCFR — 42 CFR 438.602(b)(1): the state must screen and enroll all managed care network providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-H/section-438.602)
18. [IHCP — School Corporation Services module (PROMOD00046, published Sept. 29, 2026)](https://www.in.gov/medicaid/providers/files/modules/school-corporation-services.pdf)
19. [IHCP — National Correct Coding Initiative module (PROMOD00010, v7.0, publ. Dec. 23, 2024)](https://www.in.gov/medicaid/providers/files/modules/national-correct-coding-initiative.pdf)
20. [CMS — Medicaid NCCI MUE edits, practitioner services (2026 Q4, active 10/1–12/31/2026)](https://www.cms.gov/files/zip/medicaid-ncci-2026-q4-mue-edits-practitioner-services.zip)
21. [IHCP Works 2026 — Anthem: Understanding Claims Processes](https://www.in.gov/medicaid/providers/files/IHCP-Works-2026-Anthem-Understanding-Claims-Processes.pdf)
22. [IHCP Works 2026 — Anthem: Carelon Behavioral Health (claims information)](https://www.in.gov/medicaid/providers/files/IHCP-Works-2026-Anthem-Carelon-Behavioral-Health.pdf)
23. [Anthem Blue Cross and Blue Shield — Indiana Medicaid Provider Manual (INBCBS-CD-PM-070775-24)](https://providers.anthem.com/docs/gpp/IN_CAID_ProviderManual.pdf)
24. [42 CFR 447.46 — timely claims payment by MCOs (eCFR)](https://www.ecfr.gov/current/title-42/section-447.46)
25. [Anthem Indiana — Provider News, Medicaid filter (provider news archive)](https://providernews.anthem.com/indiana/plan-type/CD)
26. [Ind. Code 27-1-37.5-26 — authorization valid for at least one year](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-26/)
27. [Ind. Code 27-1-37.5-5 — “health plan” includes Medicaid risk-based managed care](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-5/)
28. [CareSource — IHCP Works 2025 Prior Authorization 101 deck](https://www.in.gov/medicaid/providers/files/IHCP-Works-2025-CareSource-Prior-Authorization-101.pdf)
29. [Ind. Code 27-1-37.5-23 — prior authorization response deadlines](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-23/)
30. [Indiana SEA 480 (P.L.144-2025) — enrolled act adding IC 27-1-37.5-23 and -28, eff. July 1, 2025](https://iga.in.gov/pdf-documents/124/2025/senate/bills/SB0480/SB0480.06.ENRH.pdf)
31. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
32. [IHCP — Prior Authorization module (PROMOD00012, v7.2, publ. Nov. 20, 2025)](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
33. [IHCP — Third-Party Liability module (PROMOD00017, v7.2, publ. Oct. 9, 2025)](https://www.in.gov/medicaid/providers/files/modules/third-party-liability.pdf)
34. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.