MedicaidReimbursementMedium impact
BT2026122: IHCP updates reimbursement methodology for CPT code 50549
Indiana Medicaid (IHCP)·IN · Urology, Nephrology·Coding
Effective date
Jun 1, 2026
We identified it
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.
Action Required
By August 23, 2026: Billing 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. For claims with CPT 50549 and all other revenue codes, continue submitting for manual pricing review. Verify 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. Train billing staff on the new revenue code requirements and verify system configuration with Gainwell Technologies at 800-457-4584 if needed.