Indiana Medicaid Reimbursement Rates 2027: Fee Schedule

There’s no single number that answers “what does Indiana Medicaid pay?” Rates depend on the service, the procedure code, the provider type, and which fee schedule applies. Here’s what you need to know right away: for dates of service starting January 1, 2027, physician, DME, medical-supply and transportation services will shift to 100% of the applicable 2026 Medicare fee schedule rates. The anesthesia conversion factor lands at $19.58.

The Indiana Health Coverage Programs (IHCP) is the source of truth here. It publishes the official Professional Fee Schedule, along with separate schedules for outpatient services and other provider categories. There are also 2027 preview files already out for physician services, DME and medical supplies, EMS, and nonemergency medical transportation (NEMT).

If you bill Medicaid in another state too, it’s worth comparing how Medicaid reimbursement rates vary by state — Indiana’s methodology isn’t universal, and assuming otherwise is a common billing mistake.

What Changed in Indiana Medicaid Rates for 2027?

The headline change hits the IHCP Professional Fee Schedule, and it doesn’t touch every service equally.

Service category	2027 treatment
Physician services	100% of applicable 2026 Medicare fee schedule rates
DME and medical supplies	100% of applicable 2026 Medicare rates, subject to special exceptions
Transportation	Updated under the 2027 Medicare-linked methodology
EMS/EMT	2027 preview fee schedule available
NEMT	2027 preview fee schedule available
Anesthesia	$19.58 conversion factor
Dental	Not included in the general update
ABA	Not included in the general update
Home health	Not included in the general update
HCBS waiver	Not included in the general update
MRO	Not included in the general update

These changes take effect for dates of service on or after January 1, 2027. Managed care organizations (MCOs) don’t get to lag behind, either — IHCP requires them to update their fee schedules and anesthesia conversion factors to match the 2027 IHCP Professional Fee Schedule by that same date.

Indiana Medicaid 2027 Rate Schedule by Service

Indiana doesn’t run on one universal Medicaid rate. Different services get priced through different schedules, different methodologies, sometimes different logic entirely.

The official IHCP Fee Schedules page is where all of this lives: the Professional Fee Schedule, the Outpatient Fee Schedule, and additional rate information for several specialized provider categories.

Physician and Practitioner Rates

The IHCP Professional Fee Schedule lists CPT and HCPCS procedure codes, and where relevant, procedure-code/modifier combinations. It states the reimbursement amount or flags a service as noncovered, and often includes prior authorization rules, age limits, and unit limits.

Most professional pricing in Indiana runs on resource-based relative value scale (RBRVS) concepts. Where RBRVS doesn’t apply, the state falls back on maximum-fee or other pricing methods. For a lot of professional services, reimbursement comes down to whichever is lower: the provider’s submitted charge, or the established statewide allowance.

DME and Medical Supplies

DME reimbursement in Indiana Medicaid covers durable equipment and medical supplies, priced according to the procedure code, coverage policy, and applicable methodology.

IHCP has already published a preview DME and medical-supply schedule for 2027. Certain 21st Century Cures Act HCPCS codes get handled differently — they’ll use the applicable CMS 2027 DMEPOS fee schedule or competitive-bidding amount once that code information is finalized. IHCP has confirmed these updates will be retroactive to January 1, 2027.

EMS and Transportation

Ambulance and EMT services get their own 2027 preview schedule. So does nonemergency medical transportation (NEMT). Two separate documents, two separate methodologies.

Don’t assume a physician or general professional fee schedule covers a transportation claim — it doesn’t. Check the service, the procedure code, and the transportation-specific methodology separately, every time.

Anesthesia Rates

The 2027 Indiana Medicaid anesthesia conversion factor is $19.58, effective for dates of service beginning January 1, 2027.

That number alone isn’t the final payment, though. Anesthesia reimbursement also depends on procedure information, time units, modifiers, and other billing requirements — the conversion factor is one piece of the calculation, not the whole answer.

Dental, ABA, Home Health and HCBS Rates

Here’s the thing providers keep missing: not every service gets swept into the 2027 update.

IHCP explicitly excludes applied behavior analysis (ABA), dental, home health, HCBS waiver, and Medicaid Rehabilitation Option (MRO) services from the general 2027 Professional Fee Schedule change. These need to be checked against their own applicable rate information — applying physician-rate logic to them will give you the wrong number.

This is exactly why providers searching for Indiana Medicaid dental reimbursement rates 2027, Indiana Medicaid ABA reimbursement rates, or Indiana Medicaid HCBS waiver rates need to look in the right place rather than extrapolating from the physician schedule.

Hospital, FQHC, RHC and Other Medicaid Rates

Professional claims are just one slice of the picture. IHCP publishes separate rate information for:

• Outpatient hospitals and ambulatory surgical centers
• Inpatient hospitals
• Federally Qualified Health Centers (FQHCs)
• Rural Health Clinics (RHCs)
• Certified Community Behavioral Health Clinics (CCBHCs)
• Psychiatric Residential Treatment Facilities (PRTFs)
• Nursing facilities
• Hospice
• Bundled payments
• Pharmacy
• Long-term-care services

IHCP treats these as separate rate sources. Not sub-pages of one master schedule — genuinely separate.

How to Look Up an Indiana Medicaid Reimbursement Rate

Need a rate for a specific CPT, HCPCS, or other procedure code? Work through it in this order:

1. Identify the procedure code. Figure out whether it’s CPT, HCPCS, CDT, a revenue code, or something else entirely.
2. Select the correct IHCP fee schedule. Professional, outpatient, hospital, DME, transportation, and specialized services each have their own.
3. Check the effective date. A 2026 rate has no business showing up on a 2027 claim.
4. Check modifiers and units. Some procedure-code/modifier combinations carry different pricing or billing rules entirely.
5. Review coverage and prior authorization. A published rate doesn’t guarantee every member or plan covers that service under identical conditions.
6. Determine FFS or managed-care applicability. The Professional Fee Schedule applies to fee-for-service claims and acts as a floor for IHCP managed-care plans.
7. Verify the final claim rules. Manual pricing, special payment situations, coverage rules, or claim adjustments can all move the final reimbursed amount.

IHCP runs an online Professional Fee Schedule search tool, and you can also pull downloadable formats — Excel and text files both.

Does Indiana Medicaid Pay 100% of Medicare?

Not across the board. Not even close, for some categories.

For the services swept into the 2027 update, IHCP is aligning physician, DME, medical-supply, and transportation rates with 100% of the applicable prior-year Medicare fee schedule. That’s a specific policy for specific service categories — it doesn’t mean every Indiana Medicaid service runs on Medicare-based methodology.

Worth separating, too: a fee-schedule allowance and the final amount paid on an actual claim aren’t the same thing. Submitted charge, procedure code, modifiers, units, coverage rules, and other circumstances all factor into what actually gets paid.

FFS vs Managed Care Medicaid Rates

Indiana runs both fee-for-service and managed-care arrangements, and the rules diverge depending on which one applies.

For professional services, the Professional Fee Schedule governs FFS claims and sets the floor for managed-care health plans. If you’re billing through the Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise, or Indiana PathWays for Aging, check with the applicable managed care entity directly for reimbursement specifics.

Providers eligibility-checking or estimating rates should also keep Indiana Medicaid income limits in view, since eligibility category can shape which managed-care arrangement a member falls under — and that, in turn, affects which rate rules apply. A third-party database or a historical claim average isn’t the official word here. Don’t treat it like one.

Published Rates vs Actual Claims Payments

A fee schedule tells you the published reimbursement amount or the pricing rule behind it. A claims database tells you something different — what actually got paid historically, in practice.

Those two numbers can diverge. Sometimes by a lot.

For billing or rate verification, lean on the current IHCP source over an older claims dataset or a normalized third-party table. Indiana also publishes additional FFS payment information separately, to satisfy federal payment-rate transparency requirements.

How Often Are Indiana Medicaid Rates Updated?

Monthly, for the Professional Fee Schedule. IHCP updates it on the second Tuesday of each month, after 4 p.m., reflecting information current as of the previous Sunday. The Outpatient Fee Schedule moves on a slower, biannual cycle.

That monthly cadence is exactly why a downloaded spreadsheet from three months ago shouldn’t be your reference point today.

FAQs About Indiana Medicaid Reimbursement Rates 2027

What are Indiana Medicaid reimbursement rates for 2027?

They’re the payment amounts or pricing rules IHCP uses for covered Medicaid services. Rates shift based on service, procedure code, provider type, effective date, and payment methodology.

When do the 2027 Indiana Medicaid rates start?

The major Professional Fee Schedule changes apply to dates of service on or after January 1, 2027.

What is the Indiana Medicaid anesthesia conversion factor for 2027?

$19.58, effective January 1, 2027.

Where can I find the Indiana Medicaid fee schedule?

The official IHCP Fee Schedules page — it has the Professional Fee Schedule, Outpatient Fee Schedule, 2027 preview schedules, and additional rate details.

How do I find an Indiana Medicaid rate by CPT code?

Search the IHCP Professional Fee Schedule by CPT or HCPCS code, then confirm the effective date, modifiers, coverage information, units, and provider/service requirements.

Are dental and ABA rates included in the 2027 Medicare-based update?

No. IHCP specifically excludes both from the general 2027 update. Use their separate, applicable rate information instead.

Do Indiana Medicaid MCOs use the same rates?

For professional services, the Professional Fee Schedule serves as a minimum for managed-care plans. Still confirm details with the applicable MCE for managed-care claims.

Can Indiana Medicaid rates change during 2027?

Yes. IHCP updates fee schedules and issues bulletins whenever reimbursement, coverage, coding, or pricing policy shifts. The Professional Fee Schedule itself updates monthly.

Does the fee schedule show prior authorization requirements?

For applicable professional services, yes — along with age or unit limits where relevant. Still review coverage and medical-necessity rules before billing.

Conclusion

Forget trying to memorize a single Indiana Medicaid rate for 2027 — there isn’t one. You check schedules service by service, full stop. January 1 is the date that matters most. That’s when physician, DME, medical-supply, and transportation rates shift to 2026 Medicare-based amounts, and the anesthesia conversion factor lands at $19.58.

Get the procedure code right, use the correct IHCP schedule, confirm the effective date, and check whether you’re dealing with FFS or managed care. Do that, and you’ll have the real number — not a guess.

Official Resources

• Check IHCP Fee Schedules — Indiana Medicaid (IHCP)
• Find Medicare Physician Fee Schedule Rates — CMS.gov
• Verify Provider Enrollment Requirements — IHCP Provider Portal
• Get Medicaid Program Updates — Indiana FSSA

Disclaimer: That’s just how Medicaid billing works. Before you submit a claim or make any financial call based on these numbers, check the current IHCP fee schedule, the relevant bulletin, coverage policy, and managed-care requirements yourself.