---
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: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · CareSource (IN) · Last updated September 2026 · 8 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**: Required — 6-month max per IHCP; continuation needs updated progress/assessment scores [1][2]
- **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; 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]

## 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 will not authorize or reimburse 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. [5][4]
- **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. Prior authorization is required on top of the referral for every ABA service, through this plan rather than through Acentra Health. [4][5]
- **Telehealth**: Follows the Indiana Medicaid rule: effective April 1, 2026, codes 97151, 97152, 97153, 97154 and 0373T can no longer be billed with telehealth modifier 95 and require in-person delivery. The plan publishes no ABA telehealth policy of its own. [3]
- **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. [9][10][11][12]
- **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. [9][13][14]

## 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. [4][3][5]
- **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; each prior authorization is capped at 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. No per-day MUE ceiling is published at either level. [4][3]
- **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. [5]
  - 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.
- **Session-note signature** _(ask the plan)_: Neither Indiana Medicaid nor this plan publishes a session-note signature rule. The state's published signature requirements attach to the plan documents — the behavior assessment and the treatment plan must each be signed by the lead analyst and the parent or guardian — and BT202562, the bulletin titled for ABA documentation requirements, does not reach the individual session note. IHCP states its documentation requirements apply to managed care as well as fee-for-service, but also that MCEs establish and publish their own billing and reimbursement requirements, so the gap is not automatically filled at the state level. [4][5]
  - Ask the plan: The MCE directly — ask for its ABA documentation and session-note standard in writing. BT202562 also promises a future bulletin clarifying documentation requirements under the updated ABA State Plan Amendment; check for it before relying on this.

## 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 2026-07-23.

### 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

- **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)

## 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.

## 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. [CareSource — IHCP Works 2025 Prior Authorization 101 deck](https://www.in.gov/medicaid/providers/files/IHCP-Works-2025-CareSource-Prior-Authorization-101.pdf)
10. [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/)
11. [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/)
12. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
13. [42 CFR 433.139 — Medicaid third-party liability, payment of claims (eCFR)](https://www.ecfr.gov/current/title-42/section-433.139)
14. [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 September 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.