MedicaidCoverageMedium impact
BT2026137: IHCP announces coverage of additional biomarker testing codes
Indiana Medicaid (IHCP)·IN · Oncology, Pathology, Genetics·Coverage Policy
Effective date
Jul 1, 2026
We identified it
Aug 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) has expanded biomarker testing coverage to include two additional CPT codes (0211U and 0473U) effective for dates of service on or after July 1, 2026. Both codes require prior authorization and are covered under Traditional Medicaid and full-benefit IHCP plans for both managed care and fee-for-service delivery systems.
Action Required
By July 1, 2026: Billing team must update billing system and fee schedule databases to recognize CPT codes 0211U and 0473U as covered services under IHCP. Configure system to automatically require prior authorization for both codes before claim submission. Update encounter forms and provider templates to flag these codes for PA requirement. Communicate changes to all providers performing biomarker testing. For fee-for-service claims, direct prior authorization requests to Acentra Health (866-725-9991); for managed care, direct to individual MCOs. Verify coverage applies only to Traditional Medicaid and full-benefit IHCP plans—confirm patient eligibility before billing. Claims submitted without required prior authorization will be denied.