MedicaidCoverageMedium impact
BT2024125: IHCP adds physician pricing and assigns ASC pricing indicator to CPT code C9797
Indiana Medicaid (IHCP)·IN · Radiology, Vascular Surgery, Cardiology +1 more·Claims & Billing
Effective date
Aug 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) now covers CPT code C9797 for vascular embolization procedures with physician pricing at 90% of billed charges and ASC pricing indicator M for outpatient settings. Coverage is retroactive to July 1, 2024 for outpatient claims and January 1, 2024 for professional claims.
Action Required
Immediately: Billing team should identify any previously denied C9797 claims with dates of service on or after July 1, 2024 (outpatient) or January 1, 2024 (professional) and resubmit within 90 days for managed care or 180 days for fee-for-service claims. Include copy of bulletin BT2024125 with resubmissions. Update billing system to reflect 90% of billed charges for physician pricing and ASC indicator M for outpatient pricing.