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BT202599: Coverage and billing information for the July 2025 quarterly HCPCS update
Effective date
Jul 1, 2025
Identified
Jun 18, 2026
Summary
The IHCP will add the procedure codes from the July 2025 quarterly HCPCS update to its claim-processing system, effective for dates of service on or after July 1, 2025. Procedure code 91323 has been determined noncovered. Codes 0240U and 0241U have been discontinued, with alternate code considerations of 87636 and 87637. New skin-substitute codes Q4368 through Q4382 are reimbursed at a flat, statewide, per-unit rate.
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What to do
Action · 7 steps
01Already effective July 1, 2025 for dates of service on or after that date: Q4368, Q4369, Q4370, Q4371, Q4372, Q4373, Q4375, Q4376, Q4377, Q4378, Q4379, Q4380 and Q4382 are allowed for podiatrists (provider specialty 140).
02Codes J7172 and Q2058 are carved out of managed care.
03Code 91323 is noncovered for all IHCP programs.
04Codes 0240U and 0241U are discontinued, and an alternate code listed does not indicate IHCP coverage of that alternate code.
05Q2058 prior authorization criteria are to be determined, and Q5099 and Q5100 follow the Targeted Immunomodulators PA criteria.
06Direct FFS prior authorization questions to Acentra Health Customer Service at 866-725-9991, and direct FFS billing and reimbursement questions to Gainwell Technologies Customer Assistance at 800-457-4584.
07Direct managed care prior authorization, billing and reimbursement questions to the managed care entity in which the member is enrolled.
Codes mentioned
913238763687637C9174C9175C9300C9301C9302C9303C9304J0165J0166J0167J0168J0169J0171J0616J0618J1163J1326J2310J2311J2312J2313J3370J3371J3372J3373J3374J3375J7172J7356J9220J9276J9289J9340J9341J9342J9382Q2058Q4368Q4369Q4370Q4371Q4372Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4382Q5099Q5100
Original notice
BT202599: Coverage and billing information for the July 2025 quarterly HCPCS update
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 & BillingBT2020119: Additional HCPCS 2020 code updates announcedMediumEffective Oct 6, 2020 · Claims & BillingBT202476: IHCP updates HIP preventive care services exempt from copaymentHighEffective Jul 1, 2024 · Managed CareBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesPodiatryWound CareOncologyPharmacyCode 91323Code 87636Code 87637Code C9174Code C9175Code C9300Code C9301Code C9302Code C9303Code C9304Code J0165Code J0166Code J0167Code J0168Code J0169Code J0171Code J0616Code J0618Code J1163Code J1326Code J2310Code J2311Code J2312Code J2313Code J3370Code J3371Code J3372Code J3373Code J3374Code J3375Code J7172Code J7356Code J9220Code J9276Code J9289Code J9340Code J9341Code J9342Code J9382Code Q2058Code Q4368Code Q4369Code Q4370Code Q4371Code Q4372Code Q4373Code Q4375Code Q4376Code Q4377Code Q4378Code Q4379Code Q4380Code Q4382Code Q5099Code Q5100