---
title: MHS Indiana ABA coverage (Hoosier Healthwise / HIP).
url: "https://carelu.com/payers/mhs-indiana"
markdown_url: "https://carelu.com/payers/mhs-indiana.md"
state: IN (Indiana)
payer: "MHS — Managed Health Services (Indiana)"
kind: Medicaid managed care plan (MCO)
parent_program: Indiana Medicaid (IHCP)
description: "How MHS (Managed Health Services, Centene) administers Indiana Medicaid ABA — the ABA Outpatient Treatment Request form, required diagnostic and outcome instruments, utilization reporting at reauthorization, and fax workflow."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · MHS (Indiana) · Last updated September 2026 · 8 primary sources_

> IHCP criteria + MHS's own OTR form: named diagnostic instrument, outcome measure, utilization reporting.

MHS — Centene's Indiana plan, serving Hoosier Healthwise and HIP — applies the IHCP clinical criteria for ABA, but funnels every request through its own ABA Outpatient Treatment Request (OTR) form. That form is where requests live or die: it demands a named standardized diagnostic instrument with date and score, a designated outcome measure for the whole treatment episode, and utilization reporting at reauthorization. Teams that pre-collect what the form asks for start families weeks faster.

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 — MHS ABA Outpatient Treatment Request form with a named standardized diagnostic tool, date, and score [1][2]
- **Prior auth for treatment**: Required — Focused vs. Comprehensive, Initial vs. Concurrent; concurrent requests report actual vs. authorized utilization [1][2]
- **Autism diagnosis required?**: Yes — ASD with a named standardized instrument, date, and score on the OTR [1]

## At a glance

- **Plan type:** IHCP MCE (Hoosier Healthwise, HIP; Centene)
- **Clinical rules:** IHCP criteria (no distinct live MHS clinical policy)
- **Prior auth:** Required — all ABA codes on the OTR (97151–97158, 0362T, 0373T)
- **Diagnosis:** Named instrument + date + score required (ADI-R, ADOS, CARS-2, etc.)
- **Outcome measure:** One instrument for the whole episode (VB-MAPP, ABLLS, Vineland…)
- **Submission:** Fax OTR to (866) 694-3649; UM (877) 647-4848; portal accepted
- **Diagnosis recency:** State rule: CDE >1 year old needs an updated statement of need

## The OTR form is the funnel

MHS's OTR covers every ABA code and distinguishes Focused vs. Comprehensive treatment and Initial vs. Concurrent requests. The formal ASD diagnosis must name the standardized tool used — ADI-R, ADOS, CARS-2, M-CHAT, ASSQ, or GARS — with the administration date, score, and diagnosing provider. The treatment episode must also commit to at least one outcome instrument (VB-MAPP, ABLLS, AFLS, PEAK, or Vineland) used throughout, with units requested per authorization timeframe, the FBA/BIP, and parent-goal documentation attached. Incomplete or illegible forms are returned, which restarts the clock. [1][2]

At reauthorization, concurrent requests must report the "prescription fulfillment rate" — actual utilization against authorized hours. Under-delivery invites hour cuts, so requested intensity should match what the family can genuinely attend, a fact best captured at intake. [1][2]

## Intake gates

The questions that decide whether a family can start with MHS — Managed Health Services (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: 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, each with specialized training in the current DSM autism criteria. MHS adds a documentation requirement rather than a credential one — its ABA Outpatient Treatment Request form requires the diagnosing provider to be named alongside the instrument, date and score. [5][1]
- **Diagnostic tools required**: MHS is the strictest front door in Indiana on this field, because its form will not process without it. The formal ASD diagnosis must name the standardized tool used — the OTR lists ADI-R, ADOS, CARS-2, M-CHAT, ASSQ or GARS — with the administration date, the score and the diagnosing provider. Separately, the treatment episode must commit to at least one outcome instrument used throughout (VB-MAPP, ABLLS, AFLS, PEAK or Vineland). Underneath both sits the state's own behavior-assessment requirement: the Vineland Comprehensive Parent Interview Form with the Maladaptive Behavior domain, the BASC Parenting Relationship Questionnaire (BASC-4 only after October 1, 2026) and an age-appropriate direct skills assessment, with the full scoring report and graphs. Incomplete or illegible OTRs are returned, which restarts the clock. [1][4][6]
- **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**: MHS publishes the Indiana statutory clock as its own: “Urgent (expedited) PA requests will be reviewed within 24 hours of receipt of a complete request,” and “Non-urgent PA requests will be reviewed, and a determination will be issued within 48 hours of receipt of a complete request,” with “These timeframes do not include weekends or federal/state-approved holidays.” Note the clock starts on a complete request — an OTR missing a named standardized tool or the fulfillment rate is not complete. That is IC 27-1-37.5-23 (eff. 7/1/2025), which applies to Medicaid risk-based managed care and deems a service authorized if the deadline is missed; the federal floor (42 CFR 438.210(d): 7 calendar days, 72 hours expedited) is looser. Submission timing: contracted providers must request routine PAs “at least 48 hours prior to the date of service” (manual) — MHS publishes no separate ABA reauthorization lead time, only that concurrent OTRs report the prescription fulfillment rate. [9][10][11][12][13]
- **Other insurance (who pays first)**: MHS pays last: “Federal and state law requires IHCP be the payer of last resort,” and MHS says its own TPL data “is more current than IHCP data and should be used when billing MHS” (check the MHS portal, not only the state EVS). Bill the other insurance first; claims with primary insurance “must be received within 365 days of the date of service with primary EOB information” (or within 60 days of a primary EOB received after that), and COB claims sent electronically or through the portal need no paper EOP. If the other carrier does not answer within 90 days of billing, the claim can go to MHS showing the billing attempt, subject to repayment once the primary pays. Get this plan's ABA PA even when it is secondary: the IHCP Prior Authorization module says that when the member has primary coverage, the provider “must follow the primary insurer's requirements for obtaining PA and must also obtain PA from the appropriate IHCP PA contractor (based on the program assignment of the member) to receive payment from the IHCP for the balance of charges not paid by the primary insurance.” The MHS manual publishes nothing different on PA-when-secondary. 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. [10][14][15]

## Delivery and billing rules

Coverage decides whether MHS — Managed Health Services (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 MHS — Managed Health Services (Indiana)

- **Diagnostic instrument + score:** The named tool, date, score, and diagnosing provider — mandatory on the OTR and the most common intake bottleneck.
- **Outcome-measure plan:** Which instrument (VB-MAPP, Vineland, etc.) the episode will track — decide before the first request.
- **Units per code per timeframe:** The OTR requests intensity by code — align intake and clinical planning early.
- **Realistic availability:** Concurrent requests report fulfillment rate — request hours the family will actually use.

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

## Verification of benefits (VOB) data

How MHS — Managed Health Services (Indiana) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00379
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — No MHS document reviewed states or disclaims a BH carve-out for ABA specifically — inferred "none" from the OTR form describing direct PA/claims handling.
- **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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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: MHS UM (877) 647-4848 or the ABA Outpatient Treatment Request tip sheet — 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:** 877-647-4848 (MHS Provider Services; TTY/TDD 1-800-743-3333)
- **Hours:** General office 8 a.m.–5 p.m. ET, closed holidays; Member & Provider Services 8 a.m.–8 p.m.; Referrals & Authorizations 8 a.m.–5 p.m. (closed 12–1 p.m.)
- **Portal:** [MHS Secure Provider Portal](https://www.mhsindiana.com/login)
- **Fax:** Physical Health Referrals/PA: 866-912-4245 / Behavioral Health Inpatient: 844-288-2591 / Behavioral Health Outpatient: 866-694-3649

Questions to ask on a verification call:

- Does MHS's payer ID (00379) support real-time 270/271, or only batch — and is there a distinct Availity or Change Healthcare ID?
- What are the per-code unit caps, POS, and modifier requirements for this member's ABA authorization? (MHS's OTR form defers to IHCP criteria without its own table.)
- Does MHS route ABA claims through a named BH administrator, or directly under IHCP medical claims, 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.mhsindiana.com/content/dam/centene/mhsindiana/medicaid/pdfs/508-BH-IN-Medicaid-ABA-OTR.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.in.gov/medicaid/providers/files/quick-reference.pdf (accessed 2026-07-23)
- https://www.mhsindiana.com/content/dam/centene/mhsindiana/medicaid/pdfs/Provider-QRG.pdf (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does MHS Indiana cover ABA therapy?

Yes — MHS administers the IHCP ABA benefit for Hoosier Healthwise and HIP members under state clinical criteria, with prior authorization on all ABA codes via its Outpatient Treatment Request form.

### What does MHS require on an ABA authorization?

A formal ASD diagnosis with a named standardized instrument, date, and score; a committed outcome measure for the episode; units per code; the FBA/BIP; and parent goals. Fax the OTR to (866) 694-3649; incomplete forms are returned.

### What happens at MHS reauthorization?

Concurrent requests must report actual utilization versus authorized hours (the "prescription fulfillment rate") — sustained under-delivery risks reduced hours, so request what the family can actually attend.

## Primary sources

1. [MHS — ABA Outpatient Treatment Request form](https://www.mhsindiana.com/content/dam/centene/mhsindiana/medicaid/pdfs/508-BH-IN-Medicaid-ABA-OTR.pdf)
2. [MHS — Behavioral health provider forms (incl. ABA tip sheet)](https://www.mhsindiana.com/providers/behavioral-health/bh-provider-forms.html)
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. [MHS Indiana — Prior Authorization page](https://www.mhsindiana.com/providers/prior-authorization.html)
10. [MHS Provider Manual 2025 (0725.PR.P.JB)](https://www.mhsindiana.com/content/dam/centene/mhsindiana/medicaid/pdfs/Provider-Manual-2025-508.pdf)
11. [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/)
12. [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/)
13. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
14. [IHCP — Prior Authorization module (PROMOD00012, v7.2, publ. Nov. 20, 2025)](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
15. [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.