When the Department of Health and Human Services (HHS) approved Governor Mike Pence’s Healthy Indiana Plan (HIP) 2.0 Medicaid expansion alternative for Hoosiers, Indiana health care providers also received an increase in reimbursement rates through traditional and other managed care Medicaid plans.
Effective for dates of service on or after February 1, 2015, rates for most physician services will be adjusted, in aggregate, to 75% of the 2014 Medicare Physician Fee Schedule.
To estimate how this rate increase will affect your practice’s bottom line, we have created a fee schedule comparison tool that allows you to enter your top 20 procedures along with annualized utilization to see how much your revenue will change. Of course, you can always enter additional sets of 20 procedures to get a more detailed picture of your Medicaid revenue, too.
The Indiana Medicaid Fee Schedule Comparison tool is available on the CIPROMS website and is free for you to download and use.
Although rates generally will increase, reimbursement for some services may remain the same or decrease as a result of this update because they were already reimbursed at equal to or greater than 75% of the Medicare rate.
As well, there are a few notable exceptions:
- Nondelivery maternity services and prenatal services will increase, in aggregate, to 100% of the 2014 Medicare rate.
- Reimbursement rate methodology for maternity delivery services will be updated as follows: a.) 59612 – Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps) and CPT code 59620 – Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery will be changed to 100% of the 2014 Medicare rate, and b.) 59409 – Vaginal delivery only (with or without episiotomy and/or forceps) and 59514 – Cesarean delivery only will be a blended rate of the two services; both services will reimburse a maximum amount of $818.87.
- Behavioral health services will increase, in aggregate, to 80% of the 2014 Medicare rate.
- Anesthesia services will increase to approximately 75% of the 2014 Medicare rate. The anesthesia base units will be updated to the 2014 Medicare base units, and the anesthesia conversion factor will be updated to 75% of the 2014 Medicare anesthesia conversion factor of $21.68.
- Consultation codes will no longer be covered by any Medicaid plans effective for DOS on or after February 1, 2015. This includes CPT codes 99241-99245 and 99251-99255.
- The rates for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visits will increase to $87 for established patients (now $62) and $100 for new patients (now $75).
- Nonphysician practitioners’ rates whose reimbursement methodologies are based on a percentage of physician rates will be affected.
- Reimbursement for the technical component of radiology services when performed in a hospital setting remain equal to the technical rate of the radiology service when performed in the physician office setting.
- Reimbursement rates for dental, Medicaid Rehabilitation Option (MRO), waiver, durable medical equipment and medical supplies, clinics, physician-administered drugs, and clinical lab services remain unchanged.
Have questions? Need more information?
- The complete updated Medicaid fee schedule is available for you to download from the Indiana Medicaid website.
- For more information about the recent fee schedule update, review the Indiana Health Coverage Programs Bulletin 201504.
- You can also learn more about the new HIP 2.0 plan in the Indiana Health Coverage Programs Bulletin 201503.
And as always, feel free to contact CIPROMS with the questions you have and for the help you need.