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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Podiatry, Orthopedics, Nephrology +2 moreHigh impact

BT2024182: Updated coverage and billing information for the October 2024 quarterly HCPCS codes update

Effective date
Oct 1, 2024
Identified
Jun 19, 2026

Summary

Effective for dates of service on or after October 1, 2024 unless otherwise specified, the IHCP set coverage and billing rules for the October 2024 quarterly HCPCS update, which replaces the earlier October update published under BT2024154. Four newly covered codes require prior authorization: C9169, C9172, J0175 and Q5135. Several newly covered device and supply codes require attachment of manufacturer's suggested retail price documentation, or a cost invoice if no MSRP is available, and most other new codes are noncovered.

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What to do

Action · 13 steps
01Already effective October 1, 2024 for dates of service on or after that date: Get prior authorization before scheduling C9169, C9172, J0175 and Q5135, which are marked PA required, and use the PA criteria listed for each code.
02Direct FFS PA questions to Acentra Health Customer Service at 866-725-9991, and direct managed care PA questions to the managed care entity the member is enrolled with.
03Attach manufacturer's suggested retail price documentation, or a cost invoice if no MSRP is available, to claims for C8000, E0715, E0716, L8720 and L8721.
04Report NDCs on claims for drug codes marked NDC required, including J0138, J0175, J1171, J2002, J2003, J2004, J2252, J2253 and J2601.
05Link C9169, C9170, C9172, J0175, J2601, Q5135 and the newly covered skin substitute codes to revenue code 636, and link L1006, L1653, L1821, L8720 and L8721 to revenue code 274.
06Bill J2002, J2003 and J2004 as part of the renal dialysis composite rate, and note that A2027, A2028, A2029, A4544, A4545, A7021, E0469, E0683, E0715 and E0716 are included in the long-term care facility per diem rate.
07Q4334 through Q4345 and A2027 through A2029 are allowed for podiatrists (provider specialty 140) only.
08The DME codes are allowed for DME providers (provider specialty 250), and some are also allowed for home medical equipment providers (provider specialty 251).
09Note the limits: 90684 is effective for dates of service on or after June 17, 2024, is allowed once per lifetime, and is restricted to age 18 and older; L1006 is restricted to age 19 and older; J0175 is effective for dates of service on or after July 2, 2024.
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.
12For claims beyond the standard filing limit, attach the first page of this bulletin.
13The 90-day managed care and 180-day FFS timely filing windows that ran from the November 14, 2024 publication date are historical, so check current applicability rather than completing those past deadlines.

Codes mentioned

90684A2027A2028A2029A4544A4545A7021C8000C9169C9170C9172E0469E0683E0715E0716J0138J0175J1171J2002J2003J2004J2252J2253J2601L1006L1653L1821L8720L8721P9027Q4334Q4335Q4336Q4337Q4338Q4339Q4340Q4341Q4342Q4343Q4344Q4345Q5135

Original notice

BT2024182: Updated coverage and billing information for the October 2024 quarterly HCPCS codes update
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT2024154: Coverage and billing information for the October 2024 quarterly HCPCS codes updateHighEffective Oct 1, 2024 · Claims & BillingBT202520: Updated coverage and billing information for the 2025 annual HCPCS code updateHighEffective Jan 1, 2025 · Claims & BillingBT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026MediumEffective Jan 1, 2026 · Provider BulletinBT2024122: Updated coverage and billing information for the 2024 July HCPCS codesHighEffective Jul 1, 2024 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesPodiatryOrthopedicsNephrologyPulmonologyHematologyCode 90684Code A2027Code A2028Code A2029Code A4544Code A4545Code A7021Code C8000Code C9169Code C9170Code C9172Code E0469Code E0683Code E0715Code E0716Code J0138Code J0175Code J1171Code J2002Code J2003Code J2004Code J2252Code J2253Code J2601Code L1006Code L1653Code L1821Code L8720Code L8721Code P9027Code Q4334Code Q4335Code Q4336Code Q4337Code Q4338Code Q4339Code Q4340Code Q4341Code Q4342Code Q4343Code Q4344Code Q4345Code Q5135

Summaries are AI-assisted. Always confirm against the original payer notice.

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