← Back to list
BT2024211: Coverage and billing information for the 2025 annual HCPCS code update
Effective date
Jan 1, 2025
Identified
Jun 19, 2026
Summary
The IHCP set coverage and billing guidelines for the 2025 annual HCPCS update, effective for dates of service on or after January 1, 2025 unless otherwise specified. Newly covered skin substitute matrices are reimbursed at a flat statewide per-unit rate, and many newly covered codes require prior authorization, including CAR-T cell therapy, MR safety assessments, wrist and finger joint replacement and several home medical equipment devices. Most other new codes are noncovered, and the IHCP will publish coverage and pricing details once the CMS fee schedules are posted.
Get alerts when payers change rules like this one
We check Indiana Medicaid (IHCP) and other payers every day and email you when a change matches your specialty and state.
Get Indiana Medicaid (IHCP) alertsPolicy Monitoring is free. No card required.
What to do
Action · 14 steps
01Already effective January 1, 2025 for dates of service on or after that date: Get prior authorization before scheduling codes marked PA required in Table 1, for example 25448, 38225 through 38228, 61715, 76014 through 76019, 81558, 92137, C9808, E1803, E1804, E1807, E1808, E1813, E1814, E1822, E1823, E1826, E1827, E1828, E1829, G0533, G0561 through G0565, H0052, H0053, J0139, J1307, J1414, J2472, J2802, J7601, J9028 and Q5140 through Q5145, and use the PA criteria listed for each code where one is given.
02Bill the skin substitute codes Q4346 through Q4353 at the flat statewide per-unit rate.
03The codes 15011 through 15018, 81515, 87564, 87626, 98000 through 98009, 98012, 98013 and Q4346 through Q4353 are allowed for podiatrists (provider specialty 140).
04Code 92137 is allowed for optometrists (provider specialty 180) and opticians (provider specialty 190).
05The E1803 through E1829 device codes are allowed for home medical equipment providers (provider specialty 251).
06C9808 is allowed for ages 18 years and over.
07J1414 is carved out of managed care and reimbursable outside the inpatient DRG.
08The PA criteria for J0139, J1307, J1414, J2472, J2802 and Q5140 through Q5145 are posted on the PA Criteria and Administrative Forms page of the Optum Rx Indiana Medicaid website.
09Direct FFS PA questions to Acentra Health Customer Service at 866-725-9991, direct FFS reimbursement and billing questions to Gainwell Technologies at 800-457-4584, and direct managed care questions to the managed care entity the member is enrolled with.
10Standard global billing procedures and edits apply to the new codes unless special billing guidance is noted.
11Codes marked Noncovered are not covered for any IHCP program.
12Watch for the IHCP coverage and pricing publication that follows the CMS fee schedule postings.
13The 90-day managed care and 180-day FFS claim windows for codes with earlier effective dates ran from the December 19, 2024 publication date and are historical, so check current applicability rather than completing them.
14For claims beyond the standard filing limit, include the first page of this bulletin.
Codes mentioned
150111501215013150141501515016150171501825448382253822638227382284918649187491884918949190617156446664467644686446964473644747601476015760167601776018760198151581558822338223486581875138756487594876269213793896938979389896041980009800198002980039800498005980069800798008980099801298013C7565C8001C8002C8003C9808D7259E1803E1804E1807E1808E1813E1814E1822E1823E1826E1827E1828E1829G0533G0561G0562G0563G0564G0565H0052H0053J0139J0601J0602J0603J0605J0607J0608J0609J0615J0666J0870J0901J1307J1414J1552J2290J2472J2802J3392J7601J9026J9028J9076J9292M1417M1418M1419Q4346Q4347Q4348Q4349Q4350Q4351Q4352Q4353Q5139Q5140Q5141Q5142Q5143Q5144Q5145Q5146Q9996Q9997Q9998
Original notice
BT2024211: Coverage and billing information for the 2025 annual HCPCS code update
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202520: Updated coverage and billing information for the 2025 annual HCPCS code updateHighEffective Jan 1, 2025 · Claims & BillingBT202593: IHCP updates FQHC and RHC encounter codesMediumEffective Jul 28, 2025 · Provider BulletinBT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026MediumEffective Jan 1, 2026 · Provider BulletinBT202592: IHCP updates CCBHC encounter codesMediumEffective Jul 28, 2025 · Specialty ServicesBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesOrthopedicsPodiatryOptometryOphthalmologyAnesthesiologyRadiologyCode 15011Code 15012Code 15013Code 15014Code 15015Code 15016Code 15017Code 15018Code 25448Code 38225Code 38226Code 38227Code 38228Code 49186Code 49187Code 49188Code 49189Code 49190Code 61715Code 64466Code 64467Code 64468Code 64469Code 64473Code 64474Code 76014Code 76015Code 76016Code 76017Code 76018Code 76019Code 81515Code 81558Code 82233Code 82234Code 86581Code 87513Code 87564Code 87594Code 87626Code 92137Code 93896Code 93897Code 93898Code 96041Code 98000Code 98001Code 98002Code 98003Code 98004Code 98005Code 98006Code 98007Code 98008Code 98009Code 98012Code 98013Code C7565Code C8001Code C8002Code C8003Code C9808Code D7259Code E1803Code E1804Code E1807Code E1808Code E1813Code E1814Code E1822Code E1823Code E1826Code E1827Code E1828Code E1829Code G0533Code G0561Code G0562Code G0563Code G0564Code G0565Code H0052Code H0053Code J0139Code J0601Code J0602Code J0603Code J0605Code J0607Code J0608Code J0609Code J0615Code J0666Code J0870Code J0901Code J1307Code J1414Code J1552Code J2290Code J2472Code J2802Code J3392Code J7601Code J9026Code J9028Code J9076Code J9292Code M1417Code M1418Code M1419Code Q4346Code Q4347Code Q4348Code Q4349Code Q4350Code Q4351Code Q4352Code Q4353Code Q5139Code Q5140Code Q5141Code Q5142Code Q5143Code Q5144Code Q5145Code Q5146Code Q9996Code Q9997Code Q9998