MedicaidCoverageMedium impact
BT2026110: Coverage and billing information for the July 2026 quarterly HCPCS code update
Indiana Medicaid (IHCP)·IN · Oncology, Infectious Disease, Genetics +4 more·Reimbursement
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Indiana Health Coverage Programs (IHCP) has issued a July 2026 quarterly HCPCS code update notice establishing that 25+ new procedure codes (CPT 90616, 90639, and HCPCS codes 0631U-0652U) are NONCOVERED effective July 1, 2026. Billing teams should NOT submit claims for these codes until CMS pricing is implemented and IHCP issues a follow-up announcement with final reimbursement details. Claims submitted before pricing is entered into the system may be initially denied and require reprocessing.
Action Required
Before July 1, 2026: Billing team must update claim submission protocols to reflect that CPT codes 90616, 90639 and HCPCS codes 0631U through 0651U are NONCOVERED under IHCP. Do NOT submit claims using these codes for Indiana Medicaid beneficiaries. Monitor the IHCP website (in.gov/medicaid/providers) for the follow-up announcement confirming CMS pricing has been implemented before resubmitting any held claims. Update internal code lists and billing system edits to flag these codes as non-billable for Indiana Medicaid. For managed care MCO members, direct questions to the individual MCO; for FFS members, contact Gainwell Technologies at 800-457-4584. Failure to wait for the pricing implementation notice will result in claim denials and rework.