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IHCP Provider Type & Specialty Matrix

www.in.gov

IHCP Provider Enrollment Type and Specialty Matrix 2 of 41 Version 9.8. Aug. 12, 2021 Provider Type Code & Description Provider Specialty Code & Description In-State Provider Document Requirements Out-of-State Provider Document Requirements 01 – Hospital 012 – Rehabilitation (Distinct part or unit)

  Descriptions, Provider, Description provider

ABA Provider Orientation - Magellan Provider

www.magellanprovider.com

Billing CodeDescription Provider Level 8 to 12 hours or equivalent units 97151 - Initial assessment and plan development Performed by BCBA/credentialed licensed provider 1 97156 Caregiver training Provided by behavior analyst or bachelors/ non-certified support staff-level provider 1.5 97155 – Supervision ABA services rendered conjointly,

  Code, Descriptions, Provider, Magellan, Magellan provider, Description provider

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