The Indiana Medicaid Fee Schedule is an official Indiana Health Coverage Programs (IHCP) resource that shows reimbursement and coverage details for Medicaid services. It covers procedure codes, reimbursement amounts, coverage status, prior authorization requirements, modifiers, and billing limits.
Before anything else, here’s something patients consistently get wrong: a fee schedule amount is not what you’ll pay. Your Medicaid program, managed care plan, provider, and service all affect how a claim actually gets handled.
What Is the Indiana Medicaid Fee Schedule?
Indiana Health Coverage Programs (IHCP) maintains the fee schedule under the Indiana Family and Social Services Administration (FSSA). Its primary function is determining how covered services are priced within Indiana Medicaid.
The Professional Fee Schedule lists CPT and HCPCS procedure codes — and certain code-modifier combinations — showing either a reimbursement amount or a noncovered designation. It also flags prior authorization requirements, age restrictions, and unit limits.
Two questions people often confuse:
- “What rate does Indiana Medicaid use for this service?” — The fee schedule answers this.
- “How much will I personally owe?” — It doesn’t answer this.
Those are fundamentally different questions.
Indiana Medicaid Fee Schedule 2026
Indiana’s 2026 schedule includes meaningful updates. Using a rate from 2025 or earlier can give you a wrong answer — and that matters whether you’re a provider billing a claim or a patient trying to make sense of a bill.
For 2026, IHCP updated the Professional Fee Schedule for certain physician services, durable medical equipment (DME), medical supplies, and transportation using 100% of the prior year’s Medicare fee schedule rates. The anesthesia conversion factor was also updated — changed to the 2025 Medicare rate of $19.37. Dental, home health, ABA, MRO, and waiver services follow different rules.
IHCP publishes rate updates and corrections throughout the year. The effective date on the schedule isn’t a formality — it’s essential. Always treat the official IHCP fee-schedule page as the primary source, not a copied table from a third-party website.
If you’re comparing how Indiana stacks up against other states, this Medicaid fee schedule by state resource gives you a useful starting point before diving into Indiana-specific lookups.
How to Look Up an Indiana Medicaid Rate
If you need an Indiana Medicaid fee schedule lookup, the process is straightforward:
- Open the official IHCP Fee Schedules page.
- Select the Professional Fee Schedule or Outpatient Fee Schedule based on the service type.
- Search by CPT or HCPCS procedure code, code range, or description.
- Review the reimbursement amount and coverage status.
- Check for modifiers, prior authorization requirements, age restrictions, and unit limits.
- Confirm the effective date before relying on the rate.
IHCP offers an online search tool and also makes the Professional Fee Schedule available for download in Excel and text formats.
Search by CPT Code
CPT codes identify medical procedures and professional services. If you already have a code from a medical bill or explanation of benefits, searching directly by code is faster than any other method.
Search by HCPCS Code
HCPCS codes apply to a wide range of services and supplies — especially DME, transportation, and items not captured by CPT. If the service involves durable medical equipment or medical supplies, HCPCS is where you look.
Search by Description
No code? IHCP’s search tool also accepts procedure descriptions. It’s a reasonable way to identify the applicable code before checking its rate.
Indiana Medicaid Professional Fee Schedule
The Professional Fee Schedule is your go-to for professional and dental claims. It lists reimbursement information for procedure codes and applicable code-modifier combinations, and it flags:
- Reimbursement amounts
- Noncovered services
- Prior authorization requirements
- Age restrictions
- Unit limits and other billing restrictions
For fee-for-service (FFS) claims, this schedule is central. It also functions as a minimum rate for IHCP managed care health plans on applicable professional services.
Indiana Medicaid Outpatient Fee Schedule
The Outpatient Fee Schedule serves outpatient hospitals and ambulatory surgical centers (ASCs). Unlike the Professional Fee dates, it focuses on procedure and revenue codes billed for outpatient services under the FFS delivery system. IHCP publishes it as an Excel file for easy sorting and searching.
Starting in 2026, the Outpatient Fee Schedule moved from monthly to biannual updates — posted in January and July.
What Does an Indiana Medicaid Fee Mean for Patients?
Honestly, this is where most confusion happens.
A doctor performs a service. The fee schedule shows an established reimbursement amount for that CPT code. That number does not mean the patient receives a bill for that amount. Medicaid reimbursement governs how providers and health plans process payment — not what lands in your mailbox.
A patient’s actual responsibility depends on covered benefits, plan rules, provider participation, service coverage, and other circumstances specific to their situation.
Three things to keep straight:
- Fee schedule rate ≠ patient bill
- Provider charge ≠ Medicaid payment
- Medicaid reimbursement ≠ patient responsibility
If an unexpected bill shows up, contact your Medicaid plan or the provider’s billing department. Don’t assume the fee schedule tells you what you owe — it doesn’t.
Eligibility itself also affects what you’ll pay. If you’re unsure whether a service falls within your coverage, reviewing Indiana Medicaid income limits can help clarify where you stand before you even look at a fee schedule.
Indiana Medicaid Reimbursement vs. Patient Cost
The Medicaid reimbursement rate is the amount established for payment under applicable Medicaid rules. A patient’s cost is a separate calculation entirely.
A service might have an established reimbursement amount, and your actual out-of-pocket could still differ based on whether the service is covered, whether the provider participates in your plan, whether prior authorization was required, and which Medicaid program or managed care plan applies. This distinction matters especially for HIP, Hoosier Healthwise, Hoosier Care Connect, and Indiana PathWays for Aging members.
Does Indiana Medicaid Pay Medicare Rates?
Not across the board. Indiana uses specific methodologies for different services.
For certain 2026 professional services, IHCP updated rates to 100% of the prior year’s Medicare fee schedule. Other services follow different methodologies or are excluded from that update entirely. Professional services may also be priced using resource-based relative value scale (RBRVS) or maximum-fee approaches, and some services use other methods altogether.
The safest approach: check the specific procedure code and the current effective date rather than assuming Indiana Medicaid equals Medicare.
Fee-for-Service vs. Managed Care
Indiana Medicaid operates through both fee-for-service (FFS) and managed care arrangements. For FFS services, IHCP fee schedules are the central authority. For services delivered through managed care — Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise, or PathWays — providers need to get reimbursement information directly from the member’s managed care entity (MCE).
Two people on Indiana Medicaid shouldn’t assume their billing and reimbursement works identically. It often doesn’t.
Indiana Medicaid Rates by Service
IHCP publishes multiple categories of rate information. Depending on the service, you may need a different schedule than the main Professional or Outpatient fee schedule:
| Service / Category | Relevant Rate Resource |
|---|---|
| Doctors and professional services | Professional Fee Schedule |
| Dental services | Professional Fee Schedule |
| Outpatient hospitals | Outpatient Fee Schedule |
| Ambulatory surgical centers | Outpatient Fee Schedule |
| DME and medical supplies | Professional Fee Schedule / specialized info |
| FQHC services | FQHC payment rates |
| Rural health clinics | RHC payment rates |
| Inpatient hospitals | Inpatient hospital rates |
| Behavioral health | IHCP / CCBHC or applicable rate resources |
| Pharmacy | Indiana FFS State Maximum Allowable Cost |
| Transportation | Professional Fee Schedule and applicable updates |
IHCP also publishes specialized information for CCBHCs, FQHCs, inpatient hospitals, PRTFs, RHCs, bundled payments, and additional services.
Why Do Indiana Medicaid Rates Change?
Rates shift for a range of reasons:
- Annual rate updates tied to Medicare methodology changes
- New CPT or HCPCS codes entering the system
- Coverage policy changes and legislative or federal requirements
- Corrections to previously published pricing
- Adjustments to managed care requirements
In 2026, IHCP published additional FFS rate information specifically to comply with federal payment-rate transparency requirements. Established pricing for new HCPCS codes gets posted to the appropriate Professional or Outpatient Fee Schedule as updates are released.
How Often Does Indiana Update Its Fee Schedule?
The Professional Fee Schedule updates monthly — generally on the second Tuesday of each month after 4 p.m., with information current as of the previous Sunday. The Outpatient Fee Schedule updates twice a year, in January and July.
Because rates change, always verify the schedule that applies to the specific date of service.
How to Find an Indiana Medicaid Provider Near You
The fee schedule won’t help you find a doctor. For that, IHCP maintains a Provider Locator where you can search for providers eligible to serve IHCP members — whether you’re in Indianapolis, Fort Wayne, Evansville, South Bend, Gary, Bloomington, or anywhere else in Indiana.
Before booking an appointment, confirm the provider accepts your specific Medicaid program or managed care plan. Provider participation isn’t universal across all IHCP programs.
Frequently Asked Questions
What is the Indiana Medicaid fee schedule?
An IHCP resource that lists reimbursement amounts, coverage status, and billing restrictions for Medicaid services by procedure code.
Where can I find the official Indiana Medicaid fee schedule?
Through the Indiana Health Coverage Programs website. The Professional and Outpatient Fee Schedules are both linked from the IHCP Fee Schedules page.
How do I look up an Indiana Medicaid CPT code?
Use the IHCP Professional Fee Schedule search tool. Search by procedure code, code range, or description, then review the rate, coverage status, and applicable restrictions.
How much does Indiana Medicaid pay for a procedure?
There’s no universal answer. The rate depends on the procedure code, modifier, service type, effective date, and whether the service falls under FFS or managed care.
Does the fee schedule tell me what I have to pay?
No. The fee schedule addresses Medicaid reimbursement to providers — not your personal out-of-pocket responsibility.
Are Indiana Medicaid rates the same for every Medicaid plan?
Not necessarily. FFS and managed care can operate differently, and managed care entities set their own reimbursement rates for providers in their networks.
What’s the difference between the Professional and Outpatient Fee Schedules?
The Professional Fee Schedule covers professional and dental claims. The Outpatient Fee Schedule covers outpatient hospitals and ASCs and includes revenue code information alongside procedure codes.
Does Indiana Medicaid pay 100% of Medicare rates?
For certain 2026 professional services, yes — updated to 100% of the prior year’s Medicare fee schedule. Other services follow different rules.
How often does Indiana Medicaid update its rates?
The Professional Fee Schedule updates monthly. The Outpatient Fee Schedule updates twice a year starting in 2026.
Does Indiana Medicaid cover my procedure?
The fee schedule provides coverage-related information, but actual coverage depends on your specific program, prior authorization requirements, and medical circumstances. Verify before receiving a service.
How can I find a Medicaid provider in Indiana?
Use the IHCP Provider Locator. Confirm the provider accepts your specific Indiana Medicaid program or managed care plan before scheduling.
Conclusion
The 2026 Indiana Medicaid fee schedule is a real working tool — useful for understanding how Medicaid prices services, cross-checking a bill, or researching a procedure code. But it’s a starting point, not a final answer.
Get the right schedule for your service type, confirm the effective date, and check coverage details before assuming anything. If managed care is involved, go straight to your MCE. The fee schedule only tells part of the story — the rest depends on the specifics of your situation.
Official Resources
- Check Current Indiana Medicaid Fee Schedules — IHCP (in.gov)
- Find an Indiana Medicaid Provider Near You — IHCP Provider Locator (in.gov)
- Apply for Indiana Medicaid Coverage — FSSA Benefits Portal (fssabenefits.in.gov)
- See Indiana Medicaid Eligibility Requirements — Indiana Medicaid Members (in.gov)
Disclaimer: This article is for general detail guidance only and is not official Indiana Medicaid guidance. Medicaid coverage, reimbursement, and patient responsibility can vary by program, plan, service, and date of care. Always confirm latest announcements from Indiana Health Coverage Programs, your Medicaid managed care plan, or your healthcare provider before making a healthcare or billing decision.