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BT202551: IHCP updates PA criteria for CAR-T therapies
Act
immediately
Effective date
Jun 26, 2024
Identified
Jun 18, 2026
Summary
IHCP (Indiana Medicaid) removed the REMS training requirement for healthcare providers administering CAR-T therapies and expanded coverage criteria for Tecartus to include relapsed or refractory acute lymphocytic leukemia. These changes are retroactive to June 26, 2024.
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What to do
immediately · 3 steps
01Billing team should review any denied CAR-T therapy claims from June 26, 2024 forward where REMS training documentation was the denial reason and resubmit with copy of this bulletin.
02For Tecartus (Q2053), update prior authorization criteria to include acute lymphocytic leukemia as covered diagnosis.
03Submit reconsideration requests for applicable denied PAs within 180 days of April 24, 2025.
Codes mentioned
Q2041Q2042Q2053Q2054Q2055Q2056
Original notice
BT202551: IHCP updates PA criteria for CAR-T therapies
in.gov · Always check the source before changing claims.
Related changes
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