BT2026126: IHCP adds coverage for subcutaneous injection Selarsdi (Q9998) under the medical benefit

REQUIREMENTS: - By October 10, 2026 (180 days from bulletin date July 23, 2026): Billing team must submit or resubmit all retroactive FFS claims for Q9998 with DOS on or after December 13, 2025. Attach a copy of the first page of this bulletin (BT2026126) to claims filed beyond standard timely filing limits to avoid denials. - By September 22, 2026 (90 days from bulletin date for managed care): Submit retroactive managed care claims for Q9998 with the same requirements. - Immediately: Update billing software to recognize Q9998 as a covered code under the medical benefit (not pharmacy benefit) for Indiana IHCP. Link Q9998 billing to revenue code 636 for outpatient claims. Set maximum fee at $11.31 per the fee schedule. - Before next claim submission: Establish prior authorization workflow for Q9998. For FFS: direct PA requests through Acentra Health (866-725-9991). For managed care: contact individual MCO for PA procedures. Reference existing Targeted Immunomodulators Prior Authorization Criteria on Optum Rx Indiana Medicaid website. - Update claim submission protocols: Confirm Q9998 is only covered under Traditional Medicaid and full-benefit IHCP plans—NOT under limited-benefit IHCP plans. Verify member eligibility before billing. - Ensure NDC code is submitted with Q9998 claims per billing requirements. FAILURE TO ACT: Claims without prior authorization will be denied. Retroactive claims submitted after the 90/180-day windows without the bulletin attachment will exceed timely filing limits and face denial.