Ind. Code § 16-51-1-0.5 Effective date
Sec. 0.5. This chapter is effective beginning January 1, 2025.
As added by P.L.203-2023, SEC.18.
Ind. Code ch. 16-51-1
Ind. Code ch. 16-51-1
in effectInd. Code § 16-51-1-1 Applicability
Sec. 1. (a) This chapter applies to an Indiana nonprofit hospital system.
(b) This chapter does not apply to the following:
(1) A hospital licensed under IC 16-21-2 that is operated by:
(A) a county;
(B) a city pursuant to IC 16-23; or
(C) the health and hospital corporation established under IC 16-22-8.
(2) A critical access hospital that meets the criteria under 42 CFR 485.601 through 42 CFR 485.647.
(3) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
(4) A federally qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)).
(5) An oncology treatment facility, even if owned or operated by a hospital.
(6) A health facility licensed under IC 16-28.
(7) A community mental health center certified under IC 12-21-2-3(5)(C).
(8) A private mental health institution licensed under IC 12-25, including a service facility location for a private mental health institution and reimbursed as a hospital-based outpatient service site.
(9) A facility that:
(A) has a place of service code 20, as published in the place of service code set maintained by the federal Centers for Medicare and Medicaid Services; and
(B) is located in a municipality with a population of less than twenty thousand (20,000).
(10) Services provided for the treatment of individuals with psychiatric disorders or chronic addiction disorders in:
(A) any part of a hospital, whether or not a distinct part; or
(B) an outpatient off campus site that is within thirty-five (35) miles of a hospital.
(11) Billing under the Medicare program or a Medicare advantage plan.
As added by P.L.203-2023, SEC.18. Amended by P.L.216-2025, SEC.37; P.L.213-2025, SEC.156; P.L.23-2026, SEC.159.
Ind. Code § 16-51-1-2 "Health care services"
Sec. 2. (a) As used in this chapter, "health care services" means health care related services or products rendered or sold by a provider within the scope of the provider's license or legal authorization.
(b) The term includes hospital, medical, surgical, and pharmaceutical services or products.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-3 "Health maintenance organization"
Sec. 3. As used in this chapter, "health maintenance organization" has the meaning set forth in IC 27-13-1-19.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-4 "Indiana nonprofit hospital system"
Sec. 4. As used in this chapter, "Indiana nonprofit hospital system" means a hospital that:
(1) is organized as a nonprofit corporation or a charitable trust under Indiana law or the laws of any other state or country and that is:
(A) eligible for tax exempt bond financing; or
(B) exempt from state or local taxes;
(2) is licensed under IC 16-21-2;
(3) filed jointly one (1) hospital audited financial statement with the Indiana department of health in 2021; and
(4) has an annual patient service revenue of at least two billion dollars ($2,000,000,000) based on the hospital system's 2021 audited financial statement filed with the Indiana department of health. As used in this subdivision, "patient service revenue" includes similar terms, including net patient service revenue and patient care service revenue.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-5 "Individual provider form"
Sec. 5. (a) As used in this chapter, "individual provider form" means a medical claim form that:
(1) is accepted by the federal Centers for Medicare and Medicaid Services for use by individual providers or groups of providers; and
(2) includes a claim field for disclosure of the site at which the health care services to which the form relates were provided.
(b) The term includes the following:
(1) The CMS-1500 form or its successor form.
(2) The HCFA-1500 form or its successor form.
(3) The HIPAA X12 837P electronic claims transaction for professional services, or its successor transaction.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-6 "Institutional provider"
Sec. 6. As used in this chapter, "institutional provider" means any of the following:
(1) Except as provided in section 1 of this chapter, a hospital.
(2) An end stage renal disease provider.
(3) A home health agency.
(4) A hospice organization.
(5) An outpatient physical therapy, occupational therapy, or speech pathology service provider.
(6) A comprehensive outpatient rehabilitation facility.
(7) A histocompatibility laboratory.
(8) An organ procurement organization.
(9) A religious nonmedical health care institution.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-7 "Institutional provider form"
Sec. 7. (a) As used in this chapter, "institutional provider form" means a medical claim form that:
(1) is accepted by the federal Centers for Medicare and Medicaid Services for use by institutional providers; and
(2) does not include a claim field for disclosure of the site at which the health care services to which the form relates were provided.
(b) The term includes the following:
(1) The HIPAA X12 837I institutional form or its successor form.
(2) The CMS-1450 form or its successor form.
(3) The UB-04 form or its successor form.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-8 "Insurer"
Sec. 8. As used in this chapter, "insurer" has the meaning set forth in IC 27-8-11-1(e).
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-8.5 "Non-invasive treatment"
Sec. 8.5. As used in this chapter, "non-invasive treatment" means a treatment that is not included in the definition of surgery or other invasive procedure under 410 IAC 15-1.1-22.
As added by P.L.215-2025, SEC.31.
Ind. Code § 16-51-1-9 "Office setting"
Sec. 9. (a) As used in this chapter, "office setting" means a location of a qualified provider where health care services are provided and that:
(1) is located more than two hundred fifty (250) yards from the main building of any hospital owned in whole or in part by the Indiana nonprofit hospital system; and
(2) is where a qualified provider routinely provides health examinations, diagnosis, or non-invasive treatment of illness or injury on an ambulatory basis.
(b) The term does not include the following:
(1) A location within the campus (as defined in 42 CFR 413.65(a)(2)) of a hospital.
(2) A location not more than two hundred fifty (250) yards from the main building of a remote location of a hospital (as defined in 42 CFR 413.65(a)(2)).
As added by P.L.203-2023, SEC.18. Amended by P.L.215-2025, SEC.32.
Ind. Code § 16-51-1-9.5 "Payor"
Sec. 9.5. As used in this chapter, "payor" means an insurer, health maintenance organization, employer, or other person responsible for the payment of the cost of health care services provided by a qualified provider.
As added by P.L.215-2025, SEC.33.
Ind. Code § 16-51-1-10 "Qualified provider"
Sec. 10. As used in this chapter, "qualified provider" means an individual or entity employed by an Indiana nonprofit hospital system and that is duly licensed or legally authorized to provide health care services.
As added by P.L.203-2023, SEC.18. Amended by P.L.215-2025, SEC.34.
Ind. Code § 16-51-1-10.5 "Services provided for the treatment of individuals with psychiatric disorders or chronic addiction disorders"
Sec. 10.5. As used in this chapter, "services provided for the treatment of individuals with psychiatric disorders or chronic addiction disorders" means services to diagnose or treat a mental illness or substance-related or addictive disorder diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, published by the American Psychiatric Association (DSM V-TR).
As added by P.L.215-2025, SEC.35.
Ind. Code § 16-51-1-11 Individual provider form required; place of service codes; physician fee schedule
Sec. 11. (a) As used in this section, "physician fee schedule" refers to the negotiated agreement between a payor and a qualified provider specifying reimbursement for services furnished in an office setting and billed on a CMS 1500 form or its electronic equivalent.
(b) A bill for health care services provided by a qualified provider in an office setting:
(1) may not be submitted on an institutional provider form; and
(2) must be submitted on an individual provider form.
(c) A payor shall not accept a bill for health care services that is submitted on an institutional provider form.
(d) A qualified provider in an office setting may not bill health care services with a place of service code 21 or 22, as published in the place of service code set maintained by the federal Centers for Medicare and Medicaid Services.
(e) Beginning January 1, 2026, a payor shall pay the claims incurred by an in-network qualified provider based on the physician fee schedule.
As added by P.L.203-2023, SEC.18. Amended by P.L.213-2025, SEC.157; P.L.215-2025, SEC.36.
Ind. Code § 16-51-1-11.1 Remedies; dispute resolution
Sec. 11.1. (a) If, after making payment for health care services provided by a qualified provider, a payor discovers that a bill was submitted in violation of section 11 of this chapter, the payor may utilize the remedies set forth in either:
(1) the contract or other arrangement between the payor and qualified provider; or
(2) IC 27-8-5.7-10.
(b) If a qualified provider disagrees with a determination made by a payor that a bill was submitted in violation of section 11 of this chapter, the qualified provider may use the dispute resolution process set forth in the contract or other arrangement between the payor and qualified provider.
As added by P.L.215-2025, SEC.37.
Ind. Code § 16-51-1-11.3 List of facilities
Sec. 11.3. (a) Before July 1, 2025, and every two (2) years with licensure renewal, an Indiana nonprofit hospital system shall submit a complete list of facilities within the Indiana nonprofit hospital system that:
(1) qualify as an institutional provider; and
(2) may submit a bill on an institutional provider form under this chapter;
to the state department, in a manner prescribed by the state department. The list submitted under this section must include for each listed facility the appropriate place of service code, as published in the place of service code set maintained by the federal Centers for Medicaid and Medicare Services.
(b) An Indiana nonprofit hospital system shall notify the state department of:
(1) a new facility that:
(A) qualifies as an institutional provider; and
(B) may submit a bill on an institutional provider form under this chapter; or
(2) the closure or change of location of a facility that:
(A) qualifies as an institutional provider; and
(B) may submit a bill on an institutional provider form under this chapter.
The notice under this subsection must be provided not later than thirty (30) days after an event under subdivision (1) or (2) occurs.
(c) The state department shall post on the state department's website a list of the facilities, as identified under subsection (a) or (b), that:
(1) qualify as an institutional provider; and
(2) may submit a bill on an institutional provider form under this chapter.
As added by P.L.215-2025, SEC.38.
Ind. Code § 16-51-1-11.5 Violations; civil penalties
Sec. 11.5. (a) A payor or an Indiana nonprofit hospital system may report a violation of this chapter to the state department on a form prescribed by the state department.
(b) The state department may assess a civil penalty of one thousand dollars ($1,000) per day against a qualified provider for a violation of this chapter.
As added by P.L.215-2025, SEC.39.
Ind. Code § 16-51-1-12 Rules
Sec. 12. The state department shall adopt rules under IC 4-22-2 for the enforcement of this chapter.
As added by P.L.203-2023, SEC.18.
Ind. Code § 16-51-1-13 Construction of chapter
Sec. 13. Nothing in this chapter is intended to change any other billing or coding requirements that are not specifically addressed in this chapter.
As added by P.L.215-2025, SEC.40.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/16Fetched: 10/17/2026