---
title: CareSource Indiana ABA coverage (Hoosier Healthwise / HIP).
url: "https://carelu.com/payers/caresource-indiana"
markdown_url: "https://carelu.com/payers/caresource-indiana.md"
state: IN (Indiana)
payer: CareSource Indiana
kind: Medicaid managed care plan (MCO)
parent_program: Indiana Medicaid (IHCP)
description: "How CareSource administers Indiana Medicaid ABA — deference to IHCP criteria after archiving its own policy, portal-first prior authorization, the one-lead-analyst/one-agency rule, and its ABA audit posture."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# CareSource Indiana ABA coverage (Hoosier Healthwise / HIP).

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

> Defers to IHCP criteria (own policy archived); portal-first PA, one-agency rule, ABA audit posture.

CareSource serves Indiana Medicaid members on Hoosier Healthwise and HIP, and it's unusually explicit about its clinical stance on ABA: it archived its own medical policy (MM-0900) at the end of 2022 and reserves the right to follow CMS and state guidelines without a formal documented policy. In practice that means IHCP criteria govern, and the CareSource layer is process — a portal-first PA workflow, the IHCP universal form, and a documented audit posture on ABA claims.

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 — all ABA prior-authorized per IHCP criteria; portal submission preferred [1][2]
- **Prior auth for treatment** _(plan-dependent)_: Required — 6-month max per IHCP ABA policy, although CareSource's July 2025 PA deck states approved authorizations are valid for 365 calendar days; continuation needs updated progress/assessment scores [1][2][4][8][26][28]
  - 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 with a comprehensive diagnostic evaluation (CDE) + physician referral [1][4]

## At a glance

- **Plan type:** IHCP MCE (Hoosier Healthwise, HIP)
- **Clinical rules:** IHCP criteria (own ABA policy archived 12/31/2022)
- **Prior auth:** Required for all ABA; CareSource Provider Portal preferred
- **Contacts:** UM (844) 607-2831 · fax (844) 432-8924
- **One-agency rule:** One lead analyst and one ABA agency per member at a time
- **Audit posture:** Post-payment audits / prepay review on ABA compliance
- **Diagnosis recency:** State rule: CDE >1 year old needs an updated statement of need

## How CareSource runs ABA authorization

Submissions go through the CareSource Provider Portal (its stated preference, with "immediate approvals" possible for clean requests), by phone to utilization management at (844) 607-2831, or by fax to (844) 432-8924 — using the Indiana Medicaid universal PA request form; there is no CareSource-specific ABA form. The clinical package mirrors IHCP: ASD diagnosis from a licensed physician, HSPP, or qualified specialist; the comprehensive diagnostic evaluation; a behavior identification assessment and treatment plan before services; 6-month maximum authorizations under IHCP ABA policy (CareSource's own July 2025 PA deck separately says approved authorizations are "Valid for 365 calendar days," matching IC 27-1-37.5-26 — confirm the span on your approval); and continuation on updated progress and assessment scores. [1][2]

## Rules worth knowing from the archived policy

MM-0900 is no longer the operative document, but the rules it codified track state policy and remain good intake heuristics: only one lead analyst and one ABA agency per member at a time (transitions need coordination, not overlap); no coverage for services rendered by family or household members; and no coverage for shadow/paraprofessional/companion support or primarily custodial care. CareSource also explicitly runs post-payment audits and prepayment review on ABA — clean documentation from day one is a revenue-protection issue, not just a compliance one. [2]

## Is CareSource'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 CareSource'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 CareSource 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 CareSource’s network has to be enrolled with the IHCP as well. [13][14][15][16][17]

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

Filing deadline: CareSource’s 2026 IHCP Works claims and billing guide sets 90 calendar days from the date of service or discharge for participating and out-of-network providers alike, 90 calendar days from the primary payer’s EOP date for a coordination-of-benefits claim, and 60 calendar days from the EOP date for a corrected claim; for retroactive member eligibility the limit is extended to one year from the date eligibility was established. A rejected claim is not a clean claim and cannot be used as proof of timely filing. [22][23][24]

Payment clock: CareSource’s interest policy PY-1325 (effective 6/1/2026) pays interest when it fails to adjudicate an original clean claim within the applicable state and federal prompt-pay timeframes, under IC 12-15-21-3, but prints no number of days. 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. [22][23][24]

Taxonomy: CareSource’s 2026 claims guide says to “include NPI, Tax Identification Number (TIN), and taxonomy on every claim”; box 33b must carry the taxonomy that matches the group NPI’s IHCP enrollment (a “taxonomy mismatch” is a listed rejection), the group taxonomy must match CoreMMIS/the IHCP Portal, and rendering providers must be linked to the billing group NPI and active on the date of service. [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 CareSource Indiana, 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 — which is also CareSource's stated position, since it archived its own ABA policy (MM-0900) at the end of 2022 and reserves the right to follow CMS and state guidelines without a formal documented policy. The CDE must be performed by a doctoral-level licensed clinical psychologist endorsed as an HSPP, a licensed physician, a licensed APRN, or a licensed physician assistant with specialized training in the current DSM autism criteria. The archived policy's looser formulation — “licensed physician, HSPP, or qualified specialist” — is no longer the operative document. [5][1][2]
- **Diagnostic tools required**: Follows the Indiana Medicaid rule: the behavior assessment must include the Vineland Comprehensive Parent Interview Form with the Maladaptive Behavior domain, the BASC Parenting Relationship Questionnaire and an age-appropriate objective direct skills assessment, signed by the lead analyst and parent or guardian, with the complete scoring report including outcome scores and graphs submitted with the PA. Only BASC-4 satisfies the requirement after October 1, 2026. There is no CareSource-specific ABA form — submissions use the Indiana Medicaid universal PA request form — so the state's package is the package. [4][6][1]
- **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**: CareSource publishes the Indiana statutory clock, marked “Updated July 1st, 2025”: standard pre-service “Forty-eight (48) business hours” and urgent pre-service “Twenty-four (24) business hours,” both excluding weekends and holidays and each extendable 14 calendar days; urgent concurrent 48 hours with no extension; post-service (retro) 30 calendar days. That is IC 27-1-37.5-23, which applies to Medicaid risk-based managed care and deems the service authorized if a deadline is missed; the federal floor (42 CFR 438.210(d): 7 calendar days, 72 hours expedited) is looser. No ABA-specific reauthorization submission lead time is published. [28][29][27][30]
- **Other insurance (who pays first)**: CareSource is secondary to any other coverage (IHCP is payer of last resort), and it publishes its own PA-when-secondary rule, which is narrower than the IHCP module's general statement: when CareSource requires PA and another payer is primary, the “Provider must follow the primary insurers requirements and obtain prior authorization,” and must “obtain prior authorization from CareSource when primary payer’s authorization was denied partially or in full” — attaching “the primary payer's authorization denial and/or the primary payers EOP denial.” Practically: get the commercial plan's ABA authorization first; if it is cut or denied, request CareSource PA with that denial. Bill the primary first and submit its EOB/EOP with the CareSource claim. 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. [28][31][32]

## Delivery and billing rules

Coverage decides whether CareSource Indiana 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. [20][21][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 CareSource Indiana

- **Current/prior ABA agency:** The one-agency rule makes transitions a coordination task — get the outgoing provider's details and releases at intake.
- **CDE + diagnosis documentation:** Per IHCP: HSPP/physician-level evaluation, 1-year freshness, physician referral.
- **Age + prior comprehensive hours:** State under-21 cutoff and 4,000-hour lifetime allocation apply to CareSource members.
- **Documentation discipline:** CareSource's audit posture means session-note and plan quality directly protect revenue.

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

## Verification of benefits (VOB) data

How CareSource Indiana ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 01358
- **Payer ID (Availity):** 37311 — Same 2012-vintage Availity list staleness finding as every ID above — confirm against a current Availity export. (Availity also lists an "F37311" institutional variant of this same ID.)
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — CareSource's own prior-auth page describes direct PA/claims handling with no named BH administrator — inferred "none".
- **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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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: CareSource Provider Portal or UM (844) 607-2831 — 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:** 844-607-2831 (CareSource Indiana Medicaid Provider Services / Prior Authorization)
- **Portal:** [CareSource Provider Portal](https://providerportal.caresource.com/IN)
- **Fax:** 844-432-8924 (CareSource general/PA fax)

Questions to ask on a verification call:

- Does CareSource's Indiana Medicaid payer ID support real-time 270/271, and is there a distinct Change Healthcare ID?
- What are the per-code unit caps, POS, and modifier requirements for this member's ABA authorization? (CareSource's PA page defers to IHCP criteria without its own table.)
- Does CareSource administer ABA directly or via a named BH administrator for this member's plan?

### 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://www.caresource.com/in/providers/provider-portal/prior-authorization/medicaid/ (accessed 2026-07-23)
- 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://caresource.com/documents/in-hip-hhw-health-partner-manual (accessed 2026-10-14)

## Common questions

### Does CareSource Indiana cover ABA therapy?

Yes — CareSource administers the IHCP ABA benefit under state clinical criteria (it archived its own ABA policy at the end of 2022), with prior authorization on all ABA services.

### How do I submit an ABA authorization to CareSource Indiana?

Through the CareSource Provider Portal (preferred), by phone at (844) 607-2831, or fax (844) 432-8924, using the Indiana Medicaid universal PA form.

### Can a child see two ABA agencies under CareSource?

No — the plan's codified rule is one lead analyst and one ABA agency per member at a time, so provider transitions need coordinated handoffs rather than overlapping services.

### Is CareSource 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 CareSource provider contracting about panel openings.

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

CareSource publishes no rule on transferring an open ABA authorization, so expect the new agency to submit its own PA and confirm with CareSource 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 CareSource 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 CareSource (Indiana Medicaid) authorize ABA retroactively?

We have not verified CareSource Indiana’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 CareSource 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 CareSource Indiana Medicaid’s timely filing limit for ABA claims?

90 calendar days from the date of service (in or out of network); COB claims 90 days from the primary EOP; corrected claims 60 days from the EOP. CareSource publishes no payment-day figure of its own; the federal MCO floor is 90% of clean claims within 30 days.

### Does CareSource 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. [CareSource — IN Medicaid prior authorization page](https://www.caresource.com/in/providers/provider-portal/prior-authorization/medicaid/)
2. [CareSource — archived IN ABA policy MM-0900](https://www.caresource.com/documents/medicaid-in-policy-medical-mm-0900-20220601)
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 — Prior Authorization module (published Sept. 29, 2026): Retroactive Prior Authorization](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
19. [IHCP — School Corporation Services module (PROMOD00046, published Sept. 29, 2026)](https://www.in.gov/medicaid/providers/files/modules/school-corporation-services.pdf)
20. [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)
21. [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)
22. [IHCP Works 2026 — CareSource: Medicaid Provider Claims & Billing Guide](https://www.in.gov/medicaid/providers/files/IHCP-Works-2026-CareSource-Medicaid-Provider-Claims-Billing-Guide.pdf)
23. [CareSource — IN Medicaid reimbursement policy PY-1325, Interest Payments (eff. 6/1/2026)](https://www.caresource.com/documents/medicaid-in-policy-reimburse-py-1325-20260601.pdf)
24. [42 CFR 447.46 — timely claims payment by MCOs (eCFR)](https://www.ecfr.gov/current/title-42/section-447.46)
25. [CareSource Indiana — Newsletters & Communications (Medicaid ProviderSource newsletter archive)](https://www.caresource.com/in/providers/education/newsletters-communications/medicaid/)
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. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
31. [42 CFR 433.139 — Medicaid third-party liability, payment of claims (eCFR)](https://www.ecfr.gov/current/title-42/section-433.139)
32. [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.