Table 5.

Explanation of Benefits and Limits for Medicaid Insurance Coverage in Illinois and Indiana

Location	Physical Therapy Covered?	Copayment Required?	Limits on Services
Illinois	Yes	No	Previous authorization always required.∗ Coverage is limited to the following CPT codes: 97161-97164 and 97110. Limited to 4 units per day (1 unit = 15-minute increment).
Indiana	Yes	No†	Previous authorization required unless ordered by physician before hospital discharge. 12 hours/30 days or 30 therapy session/month in combination with other therapy providers.‡

CPT, Current Procedural Terminology; HIP, Healthy Indiana Plan.

^∗Previous authorization is currently waived for outpatient therapy visits due to the coronavirus disease 2019 pandemic.

^†HIP Basic (coverage under Indiana’s Section 1115 waiver) has a $4 copay.

^‡HIP Basic (coverage under Indiana's Section 1115 waiver) has a combined visit limit of 60 per year. HIP Plus has a combined visit limit of 75 per year.