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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Provider Bulletin · IN · Allergy & Immunology, Family Medicine, General Practice +3 moreHigh impact

BT2026182: COVID-19 vaccine administration to no longer be carved out of managed care

Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 30, 2026

Summary

Effective January 1, 2027, COVID-19 vaccine administration services transition from carved-out status to managed care for HIP, Hoosier Healthwise, Hoosier Care Connect, and Indiana PathWays members. Claims for COVID-19 vaccines and administration with service dates on or after 2027-01-01 must be submitted to the member's MCO instead of fee-for-service. FQHCs and RHCs remain carved out and continue submitting to FFS processors.

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What to do

by Jan 1, 2027 · 4 steps
01Billing team must update claim submission workflows to route COVID-19 vaccine administration claims (CPT 90480 and HCPCS 91304, 91318, 91319, 91320, 91321, 91322) for HIP, Hoosier Healthwise, Hoosier Care Connect, and Indiana PathWays members to the applicable MCO instead of to the fee-for-service processor.
02Exception: FQHC and RHC providers must continue submitting these claims to FFS using POS code 71 and without the T1015 encounter code.
03Verify MCO contact information and claims submission requirements in billing system.
04Update provider reference materials and internal documentation to reflect the carve-in change.

Codes mentioned

90480913049131891319913209132191322

Original notice

BT2026182: COVID-19 vaccine administration to no longer be carved out of managed care
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT202476: IHCP updates HIP preventive care services exempt from copaymentHighEffective Jul 1, 2024 · Managed CareBT2024197: IHCP announces additional COVID-19 coverage changes due to American Rescue Plan expirationMediumEffective Oct 1, 2024 · Medical PolicyBT2023123: Coverage and billing information for the 2023 October HCPCS codes updateMediumEffective Oct 1, 2023 · Claims & BillingBT2023165: Updated coverage and billing information for the 2023 October HCPCS codesMediumEffective Oct 1, 2023 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesAllergy & ImmunologyFamily MedicineGeneral PracticeInternal MedicinePediatricsPharmacyCode 90480Code 91304Code 91318Code 91319Code 91320Code 91321Code 91322

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