Why does Indiana say modifier HQ cannot be used with place of service Home?

The bulletin states modifier HQ identifies services in a 24-hour congregate or group setting and signals that electronic visit verification is not required. That combination is not valid with place of service 12 (Home); denials use EOB 4406.

Indiana: HCBS HQ+home claims deny starting Oct. 28

Indiana IHCP will deny T2033, S5151 and T2016 claims billed with modifier HQ and POS 12 (Home) for dates of service on or after Oct. 28, 2026. Bulletin BT2026155 is dated Sept. 24, 2026.

policy · indiana · hcbs · billing · waiver

Diego Delso, Wikimedia Commons, CC BY-SA 3.0

Direct Support News desk · September 24, 2026 · Updated October 3, 2026 · 1 min read

Indiana Health Coverage Programs will deny selected HCBS waiver claim lines that mix congregate-setting modifier HQ with a home place of service, starting with dates of service on or after Oct. 28, 2026. Bulletin BT2026155, dated Sept. 24, 2026, lists the edit.

What will deny

For T2033 (Participant Assistance and Care), S5151 (unskilled respite care, per diem), and T2016 (Residential Habilitation), a detail billed with both modifier HQ and place of service 12 (Home) will deny with EOB 4406. IHCP uses HQ for 24-hour congregate or group settings and to show electronic visit verification is not required. Providers must bill the modifier and place of service that match where the service was delivered.

The bulletin also adds vision claim edits for polycarbonate lenses and ultraviolet treatment that are separate from waiver billing.

Why this matters for providers and DSPs

Indiana provider agency billers and program managers should scrub pending PAC, respite, and residential habilitation claims before Oct. 28 so HQ is not paired with POS Home. Wrong combinations mean denials and delayed pay for DSP hours already worked—not a rate cut, but a claim-logic trap.

Common questions

Which Indiana HCBS codes will deny if billed with modifier HQ and POS 12 after Oct. 28, 2026?: IHCP bulletin BT2026155 says that for dates of service on or after Oct. 28, 2026, claim details for T2033 (Participant Assistance and Care), S5151 (unskilled respite care per diem), and T2016 (Residential Habilitation) will deny when billed with both modifier HQ and place of service 12 (Home).
Why does Indiana say modifier HQ cannot be used with place of service Home?: The bulletin states modifier HQ identifies services in a 24-hour congregate or group setting and signals that electronic visit verification is not required. That combination is not valid with place of service 12 (Home); denials use EOB 4406.