Who is affected by this change?

This affects Indiana Medicaid (IHCP) Orthopedics, Pathology, Oncology, OB-GYN, Infectious Disease, Pharmacy +6 more providers in IN on Medicaid plans.

When does this change take effect?

This change is effective Oct 1, 2024.

What do I need to do?

Already effective October 1, 2024 for dates of service on or after that date: Bill the new codes using the program coverage, PA required, NDC required and special billing information in Table 1. For newly covered codes that require PA, use the PA criteria in Table 3 and direct FFS PA questions to Acentra Health Customer Service at 866-725-9991. C9172 is carved out of managed care (Table 4), and A4544 is reimbursable outside the inpatient diagnosis-related group (Table 5). Table 1 marks several skin-substitute codes as allowed for Podiatrist (provider specialty 140), and Table 2 lists the skin-substitute codes reimbursed at a flat, statewide, per-unit rate. Table 7 lists the DME and supply codes included in the LTC facility per diem rate. Table 8 lists discontinued codes J1170, J2001, J8520 and J8521 with alternate code considerations of J1171, J2003 and J8522. Check pricing on the Professional Fee Schedule and Outpatient Fee Schedule on the IHCP Fee Schedules page. Direct FFS billing questions to Gainwell Technologies Customer Assistance at 800-457-4584 and managed care questions to the managed care entity the member is enrolled with. For codes with an earlier effective date, the bulletin allowed 90 days from publication for managed care claims and 180 days from publication for FFS claims to satisfy timely filing, and claims beyond the standard filing limit should include the first page of the bulletin.

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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Orthopedics, Pathology, Oncology +9 moreHigh impact

BT2024154: Coverage and billing information for the October 2024 quarterly HCPCS codes update

Q: Which billing codes are affected?

The following codes are affected: 90624, 90684, A2027, A2028, A2029, A4543, A4544, A4545, A7021, A9610, C8000, C9169, C9170, C9171, C9172, E0469, E0683, E0715, E0716, E0721, E0737, E0743, E0767, E2513, E3200, J0138, J0175, J1171, J1749, J2002, J2003, J2004, J2252, J2253, J2601, J8522, J8541, J9329, L1006, L1653, L1821, L8720, L8721, P9027, Q0519, Q0520, Q4334, Q4335, Q4336, Q4337, Q4338, Q4339, Q4340, Q4341, Q4342, Q4343, Q4344, Q4345, Q5135, Q5136, J1170, J2001, J8520, J8521.

Effective date

Oct 1, 2024

Identified

Jun 19, 2026

Summary

New CPT and HCPCS codes from the October 2024 quarterly update are effective for dates of service on or after October 1, 2024, unless otherwise specified. Table 1 gives each new code's program coverage, PA required, NDC required and special billing information, and codes 0476U through 0520U are marked noncovered. Table 2 lists new skin-substitute codes reimbursed at a flat, statewide, per-unit rate.

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What to do

Action · 9 steps

01Already effective October 1, 2024 for dates of service on or after that date: Bill the new codes using the program coverage, PA required, NDC required and special billing information in Table 1.

02For newly covered codes that require PA, use the PA criteria in Table 3 and direct FFS PA questions to Acentra Health Customer Service at 866-725-9991.

03C9172 is carved out of managed care (Table 4), and A4544 is reimbursable outside the inpatient diagnosis-related group (Table 5).

04Table 1 marks several skin-substitute codes as allowed for Podiatrist (provider specialty 140), and Table 2 lists the skin-substitute codes reimbursed at a flat, statewide, per-unit rate.

05Table 7 lists the DME and supply codes included in the LTC facility per diem rate.

06Table 8 lists discontinued codes J1170, J2001, J8520 and J8521 with alternate code considerations of J1171, J2003 and J8522.

07Check pricing on the Professional Fee Schedule and Outpatient Fee Schedule on the IHCP Fee Schedules page.

08Direct FFS billing questions to Gainwell Technologies Customer Assistance at 800-457-4584 and managed care questions to the managed care entity the member is enrolled with.

09For codes with an earlier effective date, the bulletin allowed 90 days from publication for managed care claims and 180 days from publication for FFS claims to satisfy timely filing, and claims beyond the standard filing limit should include the first page of the bulletin.

Codes mentioned

9062490684A2027A2028A2029A4543A4544A4545A7021A9610C8000C9169C9170C9171C9172E0469E0683E0715E0716E0721E0737E0743E0767E2513E3200J0138J0175J1171J1749J2002J2003J2004J2252J2253J2601J8522J8541J9329L1006L1653L1821L8720L8721P9027Q0519Q0520Q4334Q4335Q4336Q4337Q4338Q4339Q4340Q4341Q4342Q4343Q4344Q4345Q5135Q5136J1170J2001J8520J8521

Original notice

BT2024154: Coverage and billing information for the October 2024 quarterly HCPCS codes update

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

View original ↗

BT2024182: Updated coverage and billing information for the October 2024 quarterly HCPCS codes updateHighEffective Oct 1, 2024 · Claims & Billing BT202520: Updated coverage and billing information for the 2025 annual HCPCS code updateHighEffective Jan 1, 2025 · Claims & Billing BT2026117: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2026MediumEffective Jan 1, 2026 · Provider Bulletin BT202550: IHCP updates coverage for physician-administered drug codesMediumNo effective date · Pharmacy Browse every Indiana Medicaid (IHCP) change in the policy list

BT2024154: Coverage and billing information for the October 2024 quarterly HCPCS codes update

Summary

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What to do

Codes mentioned

Original notice

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