Yes. Indiana Medicaid programs, including the Healthy Indiana Plan (HIP), cover physical therapy when it is medically necessary, ordered by a qualifying provider such as a physician, and delivered by a provider enrolled with Indiana Health Coverage Programs. Under the state’s therapy rules, the initial evaluation does not need prior authorization, but most treatment after it does, and HIP Plus allows more therapy visits than HIP Basic. The matching team asks which plan you have and tells you honestly whether a therapist in the network can see you under it.
Last reviewed By the Monon Therapy Collective editorial team
- Order needed
- From a qualifying provider such as a physician or nurse practitioner
- Prior authorization
- Not for the initial evaluation; yes for most treatment
- HIP Plus vs Basic
- Plus allows more therapy visits
- Provider must be
- Enrolled with Indiana Health Coverage Programs
Does Indiana Medicaid pay for outpatient physical therapy?
Yes, when it is medically necessary. The state’s coverage chart lists physical, occupational and speech therapy as covered for Hoosier Healthwise, Hoosier Care Connect, Traditional Medicaid and Indiana PathWays for Aging, and the Healthy Indiana Plan covers therapy as one of its essential health benefits.
Two conditions sit underneath that coverage. The therapy has to need a therapist’s skill, which rules out general exercise programs, and the provider has to be enrolled with Indiana Health Coverage Programs (IHCP), the umbrella name for the state’s Medicaid programs.
Who has to order therapy for an Indiana Medicaid member?
An IHCP-enrolled provider has to order it in writing. The IHCP therapy services manual lists the providers who may order physical therapy, and the therapist cannot skip this step even though Indiana’s licensing law allows a short period of treatment without a referral for people paying another way.
- Physician (MD or DO)
- Podiatrist
- Psychologist
- Chiropractor
- Dentist
- Advanced practice registered nurse
- Physician assistant
When does Medicaid physical therapy need prior authorization?
After the evaluation, almost always. The IHCP manual, citing 405 IAC 5-22-6, requires prior authorization (PA) for physical therapy, with exceptions that include one initial evaluation per 12 months and therapy ordered in writing before you leave the hospital, for up to 30 units in 30 days after discharge.
The therapist’s office sends the PA request with your plan of treatment and progress notes. The manual also says reevaluations within 12 months need PA, therapy is not paid for more than one hour a day per type without extra approval, and for adults 21 and over rehabilitative therapy is covered for up to two years from the start of therapy unless a significant change in your condition justifies more. Managed care plans apply these rules through their own PA systems.
How do HIP Plus and HIP Basic differ for therapy?
HIP Plus covers more. The state’s HIP pages say HIP Plus allows more visits for physical, speech and occupational therapy than HIP Basic, adds vision, dental and chiropractic benefits, and has no copays apart from a non-emergency ER visit, in exchange for a monthly POWER account contribution based on income.
HIP Basic is the fallback for members with income at or below 100% of the federal poverty level who do not make POWER account contributions. It has lower service limits and copays: the state lists $4 for outpatient services including office visits. Members whose health status qualifies them as medically frail receive additional benefits the state calls HIP State Plan benefits, which continue as long as they remain medically frail.
What role does my Medicaid health plan play?
Most Indiana Medicaid members are in a managed care health plan, and that plan runs the authorization, the provider list and member services for your therapy. The state’s 2026 list of managed care plans names Anthem, CareSource and MHS (Managed Health Services) for the Healthy Indiana Plan and Hoosier Healthwise; Anthem, MHS and UnitedHealthcare for Hoosier Care Connect; and Anthem, Humana and UnitedHealthcare for PathWays for Aging. MDwise is not on that list, so if your card still names it, call the state to confirm which plan you are in now.
Call the member services number on your card and ask whether physical therapy needs a PA, how many visits are approved at a time, and whether the provider you are considering is enrolled. The page on CareSource coverage covers one plan in more detail, and the cost and insurance page explains how the matching team handles coverage questions.
