Summary
UnitedHealthcare Community Plan of Indiana revised its Maximum Dosage and Frequency medical benefit drug policy for Medicaid members in Indiana, updating the list of maximum allowed quantities and frequencies by HCPCS units and adding Exdensur (depemokimab) and Spinraza (nusinersen). Billing teams should update charge entry and claim edits for these drugs so units and administration frequency stay within the stated limits, and add HCPCS J2326 and J2361 to the applicable code set.
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What to do
Action · 4 steps
01By 2026-12-01: Billing team should update charge entry and claim edits for Medicaid members in Indiana so that Exdensur (depemokimab) and Spinraza (nusinersen), now listed with HCPCS J2326 and J2361, are billed within the revised maximum units and dosing frequencies.
02Providers and front desk staff should be told which drug units and administration frequencies are capped so orders and scheduling stay within the limits.
03Review the revised descriptions for HCPCS Q5136 and Q5157 and update the charge master and superbill descriptions to match.
04Claims that exceed the maximum allowed units or frequency will be denied, so units billed beyond the stated limits should be corrected before submission.
Codes mentioned
J2326J2361Q5136Q5157
Original notice
Maximum Dosage and Frequency
uhcprovider.com · Always check the source before changing claims.
Related changes
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