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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Wound Care, Podiatry, Oncology +3 moreMedium impact

BT202569: Updated coverage and billing information for the April 2025 quarterly HCPCS codes update

Effective date
Apr 1, 2025
Identified
Jun 18, 2026

Summary

Effective for dates of service on or after April 1, 2025, unless otherwise stated, Indiana Medicaid (IHCP) added the new procedure codes from the April 2025 quarterly HCPCS update to its fee-for-service claim-processing system. Several new codes are listed as noncovered, while covered codes carry the prior authorization, NDC, revenue code and special billing information shown in the tables. Table 10 lists discontinued codes J1300, J1810, J1940 and Q4231, with alternate code considerations J1299, J1790, J1938 and A2035.

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What to do

Action · 7 steps
01Already effective April 1, 2025, for dates of service on or after that date unless Table 1 states otherwise: Bill the new codes using the coverage, PA, NDC and special billing information in Table 1, and note that standard global billing procedures and edits apply unless special billing guidance is noted.
02Obtain prior authorization under the criteria in Table 3 for codes marked PA required, which include C9301, J1072, J2351, Q2057, E1022, E1023, E1032, E1033, E1034, E1832 and L6700.
03Direct fee-for-service PA questions to Acentra Health Customer Service at 866-725-9991, and direct managed care PA, billing and reimbursement questions to the member's managed care entity.
04Include an NDC on claims for codes marked NDC required in Table 1.
05Attach MSRP documentation, or a cost invoice if no MSRP is available, to professional claims for codes that require it.
06Modifier 26 is allowed on CPT 61715 effective April 1, 2025.
07Retroactive submissions had a 90-day window for managed care and a 180-day window for fee-for-service claims from the May 27, 2025 publication date, and that window has elapsed, so check current applicability before submitting.

Codes mentioned

A2030A2031A2032A2033A2034A2035A6515A6516A6517A6518A6519A6611A9154A9611C8004C8005C9300C9301C9302C9303C9304E0201E1022E1023E1032E1033E1034E1832G0183G0566G0567J0281J1072J1271J1299J1308J1808J1938J2351J2428J2804J2865J7521J9024J9038J9054J9161L0720L1933L1952L5827L6028L6029L6030L6031L6032L6033L6037L6700L7406Q2057Q4354Q4355Q4356Q4357Q4358Q4359Q4360Q4361Q4362Q4363Q4364Q4365Q4366Q4367Q5147Q5148Q5149Q5150Q5151Q5152Q9999S402461715J1300J1810J1940Q4231J1790

Original notice

BT202569: Updated coverage and billing information for the April 2025 quarterly HCPCS codes update
in.gov · Always check the source before changing claims.
View original ↗

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 & BillingBT202599: Coverage and billing information for the July 2025 quarterly HCPCS updateMediumEffective Jul 1, 2025 · Claims & BillingBT2024211: Coverage and billing information for the 2025 annual HCPCS code updateHighEffective Jan 1, 2025 · Claims & BillingBT202520: Updated coverage and billing information for the 2025 annual HCPCS code updateHighEffective Jan 1, 2025 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesWound CarePodiatryOncologyNeurologyNephrologyUrologyCode A2030Code A2031Code A2032Code A2033Code A2034Code A2035Code A6515Code A6516Code A6517Code A6518Code A6519Code A6611Code A9154Code A9611Code C8004Code C8005Code C9300Code C9301Code C9302Code C9303Code C9304Code E0201Code E1022Code E1023Code E1032Code E1033Code E1034Code E1832Code G0183Code G0566Code G0567Code J0281Code J1072Code J1271Code J1299Code J1308Code J1808Code J1938Code J2351Code J2428Code J2804Code J2865Code J7521Code J9024Code J9038Code J9054Code J9161Code L0720Code L1933Code L1952Code L5827Code L6028Code L6029Code L6030Code L6031Code L6032Code L6033Code L6037Code L6700Code L7406Code Q2057Code Q4354Code Q4355Code Q4356Code Q4357Code Q4358Code Q4359Code Q4360Code Q4361Code Q4362Code Q4363Code Q4364Code Q4365Code Q4366Code Q4367Code Q5147Code Q5148Code Q5149Code Q5150Code Q5151Code Q5152Code Q9999Code S4024Code 61715Code J1300Code J1810Code J1940Code Q4231Code J1790

Summaries are AI-assisted. Always confirm against the original payer notice.

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