This page provides links to the current Professional Fee Schedule and Outpatient Fee Schedule for the Indiana Health Coverage Programs (IHCP). It also includes links to additional rate information not currently included in these two fee schedules, as well as a comparative payment rate analysis file.
Professional Fee Schedule
The IHCP Professional Fee Schedule includes reimbursement information for providers that bill services using professional or dental claims. For each procedure code (and certain procedure-code-modifier combinations), the Professional Fee Schedule lists the reimbursement amount or indicates if the service is noncovered, and also notes additional information, such as if the service requires prior authorization or has age or unit limits.
Rates on the IHCP Professional Fee Schedule apply to fee-for-service (FFS) claims and also serve as minimum rates for all IHCP managed care health plans. Coverage applies to Traditional Medicaid and other IHCP programs that include full Indiana Medicaid State Plan benefits; it does not necessarily reflect coverage under a limited-benefit plan.
The entire Professional Fee Schedule can be viewed online, or a search tool is available to view only results for a specific procedure code, code range, or code description. This fee schedule can also be downloaded as a Microsoft Excel document or as a text file that can be imported into popular applications such as Microsoft Access. The Professional Fee Schedule is updated on the second Tuesday of each month, after 4 p.m., with information current as of the previous Sunday.
View Professional Fee Schedule
Outpatient Fee Schedule
The IHCP publishes the rates for outpatient hospitals and ambulatory surgical centers (ASCs) on the Outpatient Fee Schedule. This fee schedule reflects current IHCP coverage and reimbursement policy for procedure codes and revenue codes billed for IHCP outpatient services under the FFS delivery system. It is posted as a Microsoft Excel document, so providers can search and sort as needed. The Outpatient Fee Schedule is updated on a biannual basis to reflect any change in policies that occurred since the previous schedule was posted.
Additional Rate Information
Rates for the following providers are published on the Indiana Long Term Care webpage on the Myers and Stauffer website:
- State-owned psychiatric hospitals
- Intermediate care facilities for individuals with intellectual disabilities (ICF/IID)
- Nursing facilities
- Hospice care
Pharmacy ingredient rates are published on the Indiana FFS State Maximum Allowable Cost (SMAC) List of the Optum Rx website (select Indiana FFS SMAC quick link).
The following Excel files include additional FFS rate information not currently included on the IHCP fee schedules or the above websites:
- IHCP Certified Community Behavioral Health Clinic (CCBHC) Payment Rates (Effective 1/1/25)
- IHCP Federally Qualified Health Center (FQHC) Payment Rates (Effective 1/1/26)
- IHCP Inpatient Hospital Rates (Effective 8/1/25 - Except where noted)
- IHCP Psychiatric Residential Treatment Facility (PRFT) Payment Rates (Effective 1/1/24)
- IHCP Rural Health Clinic (RHC) Payment Rates (Effective 1/1/26)
- IHCP Bundled Payment Rates (Various effective dates)
- IHCP Professional Fee Schedule With Cutbacks* (Last updated 6/9/26 and effective 5/26/26)
*Note: This Professional Fee Schedule With Cutbacks file is a separate fee schedule than the one linked in the Professional Fee Schedule section earlier on this webpage. This information will be posted as a separate document until a system change has been completed to add additional columns to the monthly fee schedule posted at the link in that earlier section.
Comparative Payment Rate Analysis
In accordance with the payment rate transparency requirements of the Ensuring Access to Medicaid Services Final Rule, 89 FR 40542 (2024 Access Final Rule), Medicaid agencies are required to develop and publish a comparative payment rate analysis of Medicaid FFS payment rates for certain specified services, including primary care services, obstetrical and gynecological services, and outpatient mental health and substance use disorder (SUD) services.
The comparison is based on a list of evaluation and management (E/M) Current Procedural Terminology (CPT®1)/Healthcare Common Procedure Coding System (HCPCS) procedure codes identified by the Centers for Medicare & Medicaid Services (CMS).
States must publish their first comparative payment rate analysis by July 1, 2026, for calendar year (CY) 2025 rates. Below is the IHCP CY 2025 comparative payment rate analysis for Indiana Medicaid:
[1] CPT copyright 2026 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.