Rate Changes for 2025
As announced in IHCP Bulletin BT2024180, the IHCP will be updating rates for professional services. The IHCP Fee Schedules application page now includes the following Excel files to give providers a preview of the revised rates that will be effective for dates of service on or after Jan. 1, 2025:
- Physician Services 2025 Fee Schedule
- Durable Medical Equipment (DME) and Medical Supplies 2025 Fee Schedule
- Emergency Medical Services (EMS) 2025 Fee Schedule
- Nonemergency Medical Transportation (NEMT) 2025 Fee Schedule
The new rates will apply to fee-for-service (FFS) claims and also serve as minimum rates for all IHCP managed care health plans.
Professional Fee Schedule
The Indiana Health Coverage Programs (IHCP) Professional Fee Schedule includes reimbursement information for providers that bill services using professional or dental claims. For each procedure code (and certain procedure-code-modifier combinations), the Professional Fee Schedule lists the reimbursement amount or indicates if the service is noncovered, and also notes additional information, such as if the service requires prior authorization or has age or unit limits.
Rates on the IHCP Professional Fee Schedule apply to fee-for-service (FFS) claims and also serve as minimum rates for all IHCP managed care health plans. Coverage applies to Traditional Medicaid and other IHCP programs that include full Indiana Medicaid State Plan benefits; it does not necessarily reflect coverage under a limited-benefit plan.
The entire Professional Fee Schedule can be viewed online, or a search tool is available to view only results for a specific procedure code, code range, or code description. This fee schedule can also be downloaded as a Microsoft Excel document or as a text file that can be imported into popular applications such as Microsoft Access. The Professional Fee Schedule is updated every Tuesday after 4 p.m. with information current as of the previous Sunday.
View Professional Fee Schedule
Outpatient Fee Schedule
The IHCP publishes the rates for outpatient hospitals and ambulatory surgical centers (ASCs) on the Outpatient Fee Schedule. This fee schedule reflects current IHCP coverage and reimbursement policy for procedure codes and revenue codes billed for IHCP outpatient services under the FFS delivery system. It is posted as a Microsoft Excel document, so providers can search and sort as needed. The Outpatient Fee Schedule is updated monthly to reflect any change in policies.