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Indiana Medicaid (IHCP)Medicaid · Prior Auth · Prior Authorization · IN · Oral & Maxillofacial Surgery, ENT (Ear, Nose & Throat), Pediatrics +1 moreMedium impact

BT2024177: IHCP adds prior authorization requirement for medical and dental frenectomy codes

Act
by Dec 12, 2024
Effective date
Dec 12, 2024
Identified
Jun 19, 2026

Summary

Indiana Health Coverage Programs (IHCP) will require prior authorization for all medical and dental frenectomy procedures effective December 12, 2024. This applies to all ages with specific clinical criteria for infants versus patients over 1 year old.

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What to do

by Dec 12, 2024 · 3 steps
01Billing team must update system to require prior authorization for CPT codes 40806, 40819, 41010, 41115 and CDT codes D7961, D7962 for Indiana Medicaid patients.
02Providers must obtain prior auth before performing frenectomy procedures and maintain required documentation including referrals, photographs, and clinical notes.
03Claims without prior authorization will be denied.

Codes mentioned

40806408194101041115D7961D7962

Original notice

BT2024177: IHCP adds prior authorization requirement for medical and dental frenectomy codes
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT202109: Coverage and billing information for the 2021 annual HCPCS codes updateMediumEffective Jan 1, 2021 · Claims & BillingBT202141: IHCP updates FQHC and RHC encounter codesMediumEffective Jul 1, 2021 · Provider BulletinBT202396: IHCP removes PA requirements for newborn or infant frenectomiesMediumEffective Sep 11, 2023 · Provider BulletinBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesOral & Maxillofacial SurgeryENT (Ear, Nose & Throat)PediatricsDentistryCode 40806Code 40819Code 41010Code 41115Code D7961Code D7962

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

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