MedicaidCoverageMedium impact
BT202548: IHCP updates age range for physician-administered drug Lutathera (A9513)
Indiana Medicaid (IHCP)·IN · Oncology, Pediatrics·Pharmacy
Effective date
Apr 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) expanded the age eligibility for Lutathera (HCPCS A9513) from 18+ to 12+ years old, effective retroactively to April 1, 2024. Providers can resubmit previously denied claims for pediatric patients aged 12-17 within specified timeframes.
Action Required
By July 16, 2025 (managed care) or October 14, 2025 (fee-for-service): Billing team should identify and resubmit any previously denied claims for Lutathera (A9513) for patients aged 12-17 with dates of service April 1, 2024 or later. Include a copy of bulletin BT202548 with resubmitted claims. Contact Acentra Health (866-725-9991) for FFS prior auth questions or individual MCEs for managed care questions.