MedicaidCoverageMedium impact
BT202690: IHCP adds coverage for COVID-19 vaccine CPT code 91323
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice·Claims & Billing
Effective date
Oct 6, 2025
We identified it
Jun 18, 2026
Summary
IHCP now covers Moderna's mNexspike COVID-19 vaccine (CPT code 91323) for members age 19 and older, effective retroactively from October 6, 2025. The vaccine requires no prior authorization or NDC codes and reimburses at $185.98 maximum fee.
Action Required
Immediately: Billing team should verify CPT code 91323 is active in billing system for members age 19 and older. For institutional outpatient claims, ensure CPT 91323 is billed with revenue code 636. Claims can be submitted retroactively within 90 days for managed care or 180 days for FFS - attach first page of bulletin for late submissions. Automatic reprocessing of previous claims will appear on RAs beginning July 8, 2026.