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BT2026137: IHCP announces coverage of additional biomarker testing codes
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
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.
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What to do
by Jul 1, 2026 · 7 steps
01Billing team must update billing system and fee schedule databases to recognize CPT codes 0211U and 0473U as covered services under IHCP.
02Configure system to automatically require prior authorization for both codes before claim submission.
03Update encounter forms and provider templates to flag these codes for PA requirement.
04Communicate changes to all providers performing biomarker testing.
05For fee-for-service claims, direct prior authorization requests to Acentra Health (866-725-9991); for managed care, direct to individual MCOs.
06Verify coverage applies only to Traditional Medicaid and full-benefit IHCP plans—confirm patient eligibility before billing.
07Claims submitted without required prior authorization will be denied.
Original notice
BT2026137: IHCP announces coverage of additional biomarker testing codes
in.gov · Always check the source before changing claims.
Related changes
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