---
title: MDwise Indiana ABA coverage (Hoosier Healthwise / HIP).
url: "https://carelu.com/payers/mdwise-indiana"
markdown_url: "https://carelu.com/payers/mdwise-indiana.md"
state: IN (Indiana)
payer: MDwise (Indiana)
kind: Medicaid managed care plan (MCO)
parent_program: Indiana Medicaid (IHCP)
description: "How MDwise administers Indiana Medicaid ABA — full deference to IHCP criteria, PA on every ABA code, the delivery-system contact model, and the filing limits that matter to billing."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · MDwise (IN) · Last updated September 2026 · 6 primary sources_

> ENDED as an HIP/Hoosier Healthwise MCE effective 1/1/2026 — members reassigned to Anthem, CareSource, or MHS.

FSSA ended MDwise's participation as a managed care entity for Indiana Medicaid's Healthy Indiana Plan (HIP) and Hoosier Healthwise programs effective January 1, 2026 — following a performance review that found MDwise "both the most expensive and the lowest in quality" of the four legacy plans. MDwise members were required to choose a new plan (Anthem, CareSource, or MHS) during a Nov. 1 – Dec. 15, 2025 open-enrollment window, with automatic assignment plus a 90-day plan-change grace period for anyone who didn't choose. MDwise — a McLaren company — publishes no ABA clinical policy of its own: its Behavioral Health Reference Guide simply lists every ABA code as prior-authorization-required and points to IHCP criteria. The rest of this guide is kept for historical/reference purposes; for current Indiana Medicaid ABA authorization, use the Anthem, CareSource, or MHS guides.

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 codes PA-required (97151–97158, 0362T, 0373T) per the BH Reference Guide [3]
- **Prior auth for treatment**: Required — IHCP 6-month max applies; OTR to medical management via the member's delivery system [3][5]
- **Autism diagnosis required?**: Yes — ASD with a comprehensive diagnostic evaluation (CDE) + physician referral [5][6]

## At a glance

- **Plan status:** ENDED as an HIP/Hoosier Healthwise MCE effective January 1, 2026 — members reassigned to Anthem, CareSource, or MHS
- **Plan type (historical):** IHCP MCE (Hoosier Healthwise, HIP; McLaren)
- **Clinical rules (historical):** IHCP criteria — no MDwise ABA policy exists
- **Prior auth (historical):** Required for every ABA code, both HHW and HIP
- **Out-of-network (historical):** PA required for ALL services from non-contracted providers
- **Claim filing (historical):** 90 days contracted / 180 days non-contracted

## How MDwise runs ABA authorization

The Behavioral Health Reference Guide lists ABA codes 97151–97158, 0362T, and 0373T as PA-required across both Hoosier Healthwise and HIP, with treatment requests routed to the medical management department for the member's delivery system. There's no MDwise-specific ABA form — the IHCP universal PA form plus an outpatient treatment request does the work. Because the historical delivery-system structure means the right PA phone and fax vary, run eligibility first and pull the correct contacts from the Quick Contact Guide at MDwise.org/quickcontact rather than reusing last case's numbers. Out-of-network providers need PA for every service, and claim filing runs 90 days for contracted providers (180 non-contracted). [3][1][2]

## Intake gates

The questions that decide whether a family can start with MDwise (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. [5][4][6]
- **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. [6][5]
- **Who may diagnose**: Historical. MDwise published no ABA clinical policy of its own — its Behavioral Health Reference Guide simply listed every ABA code as prior-authorization-required and pointed to IHCP criteria — so the state rule governed: the CDE 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. MDwise ended as an HIP/Hoosier Healthwise MCE on January 1, 2026; for a current member, use the Anthem, CareSource or MHS guide. [6][3][2]
- **Diagnostic tools required**: Historical, and inherited: the state's behavior assessment with its 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 — signed by the lead analyst and parent or guardian, with the complete scoring report and graphs submitted with the PA. MDwise added no instrument requirement of its own. [5][3]
- **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. [5][6]
- **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. [4]
- **Prior-auth decision time**: Historical — MDwise left HIP and Hoosier Healthwise on January 1, 2026, and “new authorization requests for DOS on or after Jan. 1, 2026, must go to the member’s new managed care entity” (Anthem, CareSource or MHS — use that guide's clock). MDwise took requests for dates of service on or before 12/31/2025 until March 31, 2026; from April 1, 2026 its PA-UM fax lines and portal stopped accepting submissions. While active, MDwise's September 2025 manual published no decision clock of its own; as a Medicaid risk-based MCE it was bound by IC 27-1-37.5-23 (urgent 24 hours, all other 48 hours, weekends and holidays excluded) from July 1, 2025. [7][8][9][10]
- **Other insurance (who pays first)**: Historical (MDwise left HIP/Hoosier Healthwise 1/1/2026; claims for DOS on or after that date go to the new MCE). MDwise was payer of last resort: providers “must submit claims to the other insurance carrier before submitting to MDwise,” with the primary EOB “within 90 days of the date of the primary explanation of benefits,” and MDwise paid the difference up to its allowable. It paid first and chased the other carrier only for “Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program and preventive pediatric services” and IV-D child-support coverage. On PA it was explicit: with third-party coverage “the provider is still responsible for obtaining prior authorization for the service and any authorization required by the third-party payer.” A 90-day no-response rule let a claim go to MDwise with proof of the billing attempt. [8][7]

## Delivery and billing rules

Coverage decides whether MDwise (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. [5][4][6]
- **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. [5][4]
- **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. [5]
- **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. [5][4]
- **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. [6]
  - 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. [5][6]
  - 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 MDwise (Indiana)

- **Redirect to new MCE:** MDwise no longer serves HIP/Hoosier Healthwise as of 1/1/2026 — confirm which of Anthem, CareSource, or MHS the member was reassigned to, and use that guide.
- **IHCP clinical package:** CDE, physician referral, behavior assessment with Vineland/BASC — state criteria govern regardless of MCE.
- **Continuity of care:** FSSA states existing authorizations/treatments are honored through a transition period — verify current status with the new plan.

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

## Verification of benefits (VOB) data

How MDwise (Indiana) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 000923 (MDWISE Medicaid Health Plans) — legacy sub-plan IDs also on file: 06068 (Hoosier Healthwise), 00381 (Hoosier Alliance), 01180 (Exchange) — HISTORICAL ONLY — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026 (FSSA press release); these IDs should NOT be used to route a live eligibility check. Route current requests to anthem-indiana-medicaid, caresource-indiana, or mhs-indiana instead, per the member's reassigned plan.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Behavior identification assessment by professional, each 15 minutes. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Behavior identification assessment by technician, each 15 minutes. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. 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: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Group ABA treatment by technician — group-size modifier required; no individual/non-group rate exists for this code. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. 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: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Adaptive behavior treatment by professional with family. Excluded from the 4,000-hour comprehensive-ABA lifetime allocation. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Group-only code — no individual/non-group rate exists. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Behavior identification supporting assessment for destructive behavior, technician face-to-face time. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** HISTORICAL — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; members were reassigned to Anthem, CareSource, or MHS. Adaptive behavior treatment with protocol modification for destructive behavior, technician face-to-face time. Verify via: N/A — MDwise no longer administers Indiana Medicaid ABA claims; use the member's reassigned MCE guide — 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:** 1-833-654-9192 (MDwise Provider Customer Service Unit) — HISTORICAL ONLY: MDwise ended as an Indiana Medicaid MCE effective 1/1/2026; do not use to route a live 2026+ eligibility check
- **Portal:** [myMDwise Provider Portal (historical)](https://www.mdwise.org/for-providers/mymdwise-provider-portal)
- **Fax:** 1-463-426-5854 (historical Provider Customer Service Unit fax)

Questions to ask on a verification call:

- If a member's ID card still shows MDwise, confirm their reassigned MCE (Anthem, CareSource, or MHS) before proceeding — MDwise ended as an Indiana Medicaid MCE effective 1/1/2026.

### 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.mdwise.org/Uploads/Public/Documents/MDwise/BH-Reference-Guide.pdf (accessed 2026-07-23)
- https://www.in.gov/fssa/files/MDwise-Participation_FINAL-2025.pdf (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.mdwise.org/Uploads/Public/Documents/MDwise/MDwise-Quick-Contact-Guide.pdf (accessed 2026-07-23)

## Common questions

### Does MDwise still cover ABA therapy in Indiana?

No — FSSA ended MDwise's participation as an MCE for HIP and Hoosier Healthwise effective January 1, 2026. Members were reassigned to Anthem, CareSource, or MHS; use those guides for current ABA authorization.

### What happened to MDwise members?

They chose a new plan (Anthem, CareSource, or MHS) during a Nov. 1 – Dec. 15, 2025 open-enrollment window, or were auto-assigned with a 90-day window to switch after January 1, 2026. FSSA states coverage and existing authorizations continue through the transition.

### Why did Indiana end MDwise's Medicaid contract?

FSSA's review found MDwise was "both the most expensive and the lowest in quality" of the four legacy plans; federal rules require at least three plans, which the state still meets with Anthem, CareSource, and MHS.

## Primary sources

1. [FSSA — Announces End of MDwise Participation in Indiana Medicaid Programs (11/12/2025)](https://www.in.gov/fssa/files/MDwise-Participation_FINAL-2025.pdf)
2. [IHCP Bulletin BT2025157 — MDwise to end participation as a managed care health plan (11/12/2025)](https://www.in.gov/medicaid/providers/files/bulletins/BT2025157.pdf)
3. [MDwise — Behavioral Health Reference Guide (historical)](https://www.mdwise.org/Uploads/Public/Documents/MDwise/BH-Reference-Guide.pdf)
4. [IHCP Bulletin BT202627 — ABA policy updates](https://www.in.gov/medicaid/providers/files/bulletins/BT202627.pdf)
5. [IHCP — Behavioral Health Services module (PROMOD00039, ABA section)](https://www.in.gov/medicaid/providers/files/modules/behavioral-health-services.pdf)
6. [IHCP Bulletin BT202562 — ABA documentation requirements (5/2025)](https://www.in.gov/medicaid/providers/files/bulletins/BT202562.pdf)
7. [IHCP Bulletin BT2025183 — MDwise PA-UM transition update (12/18/2025)](https://www.in.gov/medicaid/providers/files/bulletins/BT2025183.pdf)
8. [MDwise — Hoosier Healthwise and HIP Provider Manual (historical)](https://www.mdwise.org/Uploads/Public/Documents/MDwise/hhw_hip_providermanual.pdf)
9. [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/)
10. [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/)

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.