IHCP to remove age restriction on structured family caregiving waiver services under A&D waiver
IHCP to remove age restriction on structured family caregiving waiver
services under the A&D HCBS program, and accept resubmitted claims
Effective immediately, the Indiana Health Coverage Programs (IHCP) will remove the age restriction on certain structured family caregiving (SFC) waiver services under the Aged and Disabled (A&D) Home and Community-Based Services (HCBS) program. Services billed for Healthcare Common Procedure Coding System (HCPCS) code S5140 – Adult foster care; per diem, in combination with modifier U7 and modifier U1, U2, or U3, had been restricted to IHCP members ages 18 and older. The age restriction no longer applies. Other existing reimbursement guidelines for code S5140 in combination with these modifiers remain unchanged. Removal of the age restriction applies retroactively to fee-for-service (FFS) claims with dates of service (DOS) on or after January 1, 2019.
Claims billed for code S5140 with the modifiers indicated above may have denied for explanation of benefits (EOB) 4034 – Service billed not compatible with the members age. Please verify and resubmit.
Effective immediately, the Indiana Health Coverage Programs (IHCP) will remove the age restriction on certain structured family caregiving (SFC) waiver services under the Aged and Disabled (A&D) Home and Community-Based Services (HCBS) program. Services billed for Healthcare Common Procedure Coding System (HCPCS) code S5140 – Adult foster care; per diem, in combination with modifier U7 and modifier U1, U2, or U3, had been restricted to IHCP members ages 18 and older. The age restriction no longer applies. Other existing reimbursement guidelines for code S5140 in combination with these modifiers remain unchanged. Removal of the age restriction applies retroactively to fee-for-service (FFS) claims with dates of service (DOS) on or after January 1, 2019.
Claims billed for code S5140 with the modifiers indicated above may have denied for explanation of benefits (EOB) 4034 – Service billed not compatible with the members age. Please verify and resubmit.
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