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BT2025111: IHCP provides PA criteria for newly added physician-administered drug Tecelra (Q2057)
Effective date
Apr 1, 2025
Identified
Jun 18, 2026
Summary
Indiana Medicaid has established prior authorization criteria for newly covered HCPCS code Q2057 (Tecelra), a specialized cancer treatment for adults with synovial sarcoma. The drug requires strict eligibility criteria including prior chemotherapy, specific genetic markers, and tumor expression testing.
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What to do
Action · 3 steps
01By next billing cycle: Billing team must update system to flag HCPCS code Q2057 for prior authorization requirements through Acentra Health (866-725-9991) before billing.
02Ensure all Q2057 claims include required NDC codes and use revenue code 636 for institutional outpatient claims.
03Submit FFS claims to Gainwell Technologies.
Codes mentioned
Q2057
Original notice
BT2025111: IHCP provides PA criteria for newly added physician-administered drug Tecelra (Q2057)
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202546: Coverage and billing information for the April 2025 quarterly HCPCS codes updateHighEffective Apr 1, 2025 · Claims & BillingBT202569: Updated coverage and billing information for the April 2025 quarterly HCPCS codes updateMediumEffective Apr 1, 2025 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list