Who is affected by this change?

This affects Indiana Medicaid (IHCP) Oncology, Hematology, Neurology, Endocrinology, Nephrology, Podiatry +3 more providers in IN on Medicaid plans.

When does this change take effect?

This change is effective Apr 1, 2025.

What do I need to do?

Billing team: for the new codes in Table 1 effective for dates of service on or after April 1, 2025, bill them with the standard global billing procedures and edits unless the table gives special billing guidance. Billing team: for codes marked Yes for prior authorization, check the criteria in Table 3, including the Durable and Home Medical Equipment and Supplies provider reference module for the wheelchair, orthosis and accessory codes and the Testosterones and Multiple Sclerosis Agents criteria for J1072 and J2351. For C9301, the criteria require that the patient is at least 18 years of age, has a diagnosis of relapsed or refractory B-cell precursor ALL, has not previously received the Aucatzyl treatment, and will receive the Aucatzyl treatment at an Aucatzyl-certified facility. Billing team: for codes discontinued in Table 8, use the alternate codes listed (A9155 to A9154, J1300 to J1299, J1940 to J1938, Q4231 to A2035), and note that an alternate code does not indicate IHCP coverage of that code, so consult the Professional Fee Schedule. Billing team: C9301 and C9304 are carved out of managed care (Table 4), C9301 through C9304 are reimbursable outside the inpatient DRG (Table 5), and J1938 is included in the renal dialysis composite rate (Table 6). Direct questions about fee-for-service prior authorization to Acentra Health Customer Service at 866-725-9991 and fee-for-service billing questions to Gainwell Technologies Customer Assistance at 800-457-4584. For managed care members, direct prior authorization and billing questions to the managed care entity the member is enrolled with.

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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Oncology, Hematology, Neurology +6 moreHigh impact

BT202546: Coverage and billing information for the April 2025 quarterly HCPCS codes update

Q: Which billing codes are affected?

The following codes are affected: C9301, C9302, C9303, C9304, J1072, J2351, J1938, J1940, J1300, J1299, A9155, A9154, Q4231, A2035, A2030, A2031, A2032, A2033, A2034, Q4354, Q4367, E1022, E1023, E1032, E1033, E1034, E1832, L6700, A6515, A6516, A6517, A6518, A6611, J0281, J1808, Q5147, C9300, J9054, C8004, A9611, Q2057.

Effective date

Apr 1, 2025

Identified

Jun 19, 2026

Summary

New codes in the April 2025 quarterly HCPCS update are effective for dates of service on or after April 1, 2025, and the IHCP will publish coverage and pricing information after its final review of CMS fee schedules. Codes C9301, J1072 and J2351 require prior authorization, and C9301 has listed criteria for patients at least 18 years of age with relapsed or refractory B-cell precursor acute lymphoblastic leukemia who will receive the Aucatzyl treatment at an Aucatzyl-certified facility. Discontinued codes A9155, J1300, J1940 and Q4231 have alternate codes A9154, J1299, J1938 and A2035 to consider.

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What to do

Action · 7 steps

01Billing team: for the new codes in Table 1 effective for dates of service on or after April 1, 2025, bill them with the standard global billing procedures and edits unless the table gives special billing guidance.

02Billing team: for codes marked Yes for prior authorization, check the criteria in Table 3, including the Durable and Home Medical Equipment and Supplies provider reference module for the wheelchair, orthosis and accessory codes and the Testosterones and Multiple Sclerosis Agents criteria for J1072 and J2351.

03For C9301, the criteria require that the patient is at least 18 years of age, has a diagnosis of relapsed or refractory B-cell precursor ALL, has not previously received the Aucatzyl treatment, and will receive the Aucatzyl treatment at an Aucatzyl-certified facility.

04Billing team: for codes discontinued in Table 8, use the alternate codes listed (A9155 to A9154, J1300 to J1299, J1940 to J1938, Q4231 to A2035), and note that an alternate code does not indicate IHCP coverage of that code, so consult the Professional Fee Schedule.

05Billing team: C9301 and C9304 are carved out of managed care (Table 4), C9301 through C9304 are reimbursable outside the inpatient DRG (Table 5), and J1938 is included in the renal dialysis composite rate (Table 6).

06Direct questions about fee-for-service prior authorization to Acentra Health Customer Service at 866-725-9991 and fee-for-service billing questions to Gainwell Technologies Customer Assistance at 800-457-4584.

07For managed care members, direct prior authorization and billing questions to the managed care entity the member is enrolled with.

Codes mentioned

C9301C9302C9303C9304J1072J2351J1938J1940J1300J1299A9155A9154Q4231A2035A2030A2031A2032A2033A2034Q4354Q4367E1022E1023E1032E1033E1034E1832L6700A6515A6516A6517A6518A6611J0281J1808Q5147C9300J9054C8004A9611Q2057

Original notice

BT202546: Coverage and billing information for the April 2025 quarterly HCPCS codes update

in.gov · Always check the source before changing claims.

View original ↗

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BT202546: Coverage and billing information for the April 2025 quarterly HCPCS codes update

Summary

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What to do

Codes mentioned

Original notice

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