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Indiana Medicaid (IHCP)Medicaid · Reimbursement · Coding · IN · Urology, NephrologyMedium impact

BT2026122: IHCP updates reimbursement methodology for CPT code 50549

Act
by Aug 23, 2026
Effective date
Jun 1, 2026
Identified
Jul 28, 2026

Summary

Effective June 1, 2026 (retroactive), IHCP changes CPT 50549 (kidney endoscopic procedure) reimbursement from manual review to automated ASC group H rate when billed with specific surgical revenue codes (036X, 049X, and 18 other qualifying codes). Claims with non-qualifying revenue codes continue to require manual pricing review.

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What to do

by Aug 23, 2026 · 4 steps
01Billing team must update billing system to recognize CPT 50549 with qualifying revenue codes (036X, 049X, 450, 456, 459, 48X, 510-517/519, 52X, 700, 710, 72X, 760, 761) and apply ASC group H reimbursement rates automatically instead of submitting for manual review.
02For claims with CPT 50549 and all other revenue codes, continue submitting for manual pricing review.
03Verify that all CPT 50549 claims with DOS on or after June 1, 2026 are being processed under the new methodology; resubmit any previously denied or manually priced claims that should qualify for ASC group H rate.
04Train billing staff on the new revenue code requirements and verify system configuration with Gainwell Technologies at 800-457-4584 if needed.

Codes mentioned

50549

Original notice

BT2026122: IHCP updates reimbursement methodology for CPT code 50549
in.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesUrologyNephrologyCode 50549

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