MedicaidCoverageMedium impact
BT2026132: IHCP announces additional diagnosis codes for medical necessity of botulinum toxin injections
Indiana Medicaid (IHCP)·IN · Neurology, Pain Management, Dermatology·Provider Bulletin
Effective date
Oct 1, 2023
We identified it
Aug 7, 2026
Summary
Indiana Health Coverage Programs (IHCP) has announced 11 additional ICD-10 diagnosis codes that support medical necessity for botulinum toxin (Botox) injections. These codes—covering multiple sclerosis variants and chronic migraine conditions—are now accepted for reimbursement with retroactive and prospective effective dates. Billing teams must update their systems to recognize these codes as valid medical necessity indicators for Botox injection claims to avoid denials.
Action Required
Immediately: Billing team must update the diagnosis code validation rules in the billing system to recognize all 12 ICD-10 codes listed in Table 1 as valid medical necessity indicators for botulinum toxin injection claims. Effective dates vary: G43E01, G43E09, G43E11, and G43E19 are retroactive to October 1, 2023; all multiple sclerosis codes (G35A, G35B0, G35B1, G35B2, G35C0, G35C1, G35C2, G35D) are retroactive to October 1, 2025. Verify current claims submitted for dates of service on or after these effective dates to identify any previously denied claims that should be reprocessed. Add these codes to any internal reference documentation or payer-specific billing guidelines. Contact IHCP Customer Assistance at 800-457-4584 with questions about claim adjustments or appeals.