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BT202649: Coverage and billing information for the April 2026 quarterly HCPCS codes update
Effective date
Apr 1, 2026
Identified
Jun 18, 2026
Summary
The Indiana Health Coverage Programs (IHCP) set coverage and billing information for procedure codes added in the April 2026 quarterly HCPCS update, effective for dates of service on or after April 1, 2026. Codes marked noncovered are not covered for any IHCP program. Pricing for the new codes depends on CMS fee schedules that were still awaiting final posting, and claims submitted before pricing is entered into the claim-processing system may initially be denied.
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What to do
Action · 7 steps
01Already effective April 1, 2026: Billing team, for dates of service on or after April 1, 2026, wait until the IHCP announces that pricing has been implemented for these codes before submitting claims for them, because the IHCP encourages waiting and claims submitted before pricing is entered may initially be denied.
02Watch for the IHCP publication that announces pricing has been implemented and details the NDC requirements and prior authorization criteria for these codes.
03Get prior authorization for C9309, J3404, Q5161 and Q5162, which the table lists as requiring prior authorization, and check the later IHCP publication for the criteria.
04For J9183, J9277 and J9601, the table lists prior authorization and NDC status as TBD, so check the later IHCP publication before billing.
05Bill the wound membrane and skin substitute codes listed as allowed for podiatrists (provider specialty 140), including A2040 through A2045, under that provider specialty.
06Bill the new codes under the standard global billing procedures and edits unless the special billing information says otherwise.
07Direct FFS prior authorization questions to Acentra Health Customer Service at 866-725-9991, direct FFS billing and reimbursement questions to Gainwell Technologies Customer Assistance at 800-457-4584, and direct managed care questions to the member's managed care entity.
Codes mentioned
A2040A2041A2042A2043A2044A2045A4318A4479A6548A8005A8006A9294C1743C8007C8008C8009C8010C8011C8012C8013C9309C9818G0680G0681G0682G0683G0684J0463J1098J1164J1553J3404J8502J9003J9183J9277J9278J9601L2221L5992M0233M0234Q0238Q4418Q4419Q4421Q4422Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436Q4437Q4438Q4439Q4440Q5161Q5162
Original notice
BT202649: Coverage and billing information for the April 2026 quarterly HCPCS codes update
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202678: Updated coverage and billing information for the April 2026 quarterly HCPCS codes updateMediumEffective Apr 1, 2026 · Claims & BillingBT202437: Coverage information for the April 2024 quarterly HCPCS updateMediumEffective Apr 1, 2024 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesPodiatryWound CareOncologyUrologyNeurologyPediatricsOphthalmologyCode A2040Code A2041Code A2042Code A2043Code A2044Code A2045Code A4318Code A4479Code A6548Code A8005Code A8006Code A9294Code C1743Code C8007Code C8008Code C8009Code C8010Code C8011Code C8012Code C8013Code C9309Code C9818Code G0680Code G0681Code G0682Code G0683Code G0684Code J0463Code J1098Code J1164Code J1553Code J3404Code J8502Code J9003Code J9183Code J9277Code J9278Code J9601Code L2221Code L5992Code M0233Code M0234Code Q0238Code Q4418Code Q4419Code Q4421Code Q4422Code Q4423Code Q4424Code Q4425Code Q4426Code Q4427Code Q4428Code Q4429Code Q4435Code Q4436Code Q4437Code Q4438Code Q4439Code Q4440Code Q5161Code Q5162