MedicaidBilling CodesHigh impact
BT2026140: IHCP reminds providers of E/M and physician-administered drug guidance
Indiana Medicaid (IHCP)·IN·Provider Bulletin
Effective date
Aug 20, 2026
We identified it
Aug 21, 2026
Summary
IHCP clarifies that when an E/M code is billed on the same date of service as physician-administered drug administration, providers must NOT bill a separate drug administration procedure code. The administration cost is included in the E/M reimbursement. Providers may use NCCI PTP-associated modifiers when clinically appropriate to bypass edits, per NCCI guidelines.
Action Required
Immediately: Billing team must implement edits in billing software to prevent submission of separate drug administration procedure codes (HCPCS or CPT codes for administration/vaccines) when an E/M code is billed on the same date of service for IHCP claims. Providers and billing staff must be trained that administration reimbursement is bundled into the E/M code on same-DOS claims. Audit claims submitted in the past 30 days for violations and resubmit corrected claims if necessary. Establish claim scrubbing rules to flag E/M + drug administration code combinations and remove the procedure code before submission.