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BT2024122: Updated coverage and billing information for the 2024 July HCPCS codes
Effective date
Jul 1, 2024
Identified
Jun 19, 2026
Summary
The Indiana Health Coverage Programs (IHCP) published updated coverage and billing information for the July 2024 quarterly HCPCS update, replacing bulletin BT202497. It is effective for dates of service on or after July 1, 2024, unless otherwise specified. Most of the new codes are noncovered, while the covered codes include skin-substitute codes Q4311 through Q4333 paid at a flat statewide per-unit rate, several drug codes, and the endoscopic defect closure code C9901.
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What to do
Action · 20 steps
01Already effective for dates of service on or after July 1, 2024, unless otherwise specified: Billing team should check the Program coverage, PA required and NDC required columns in Table 1 for each code before billing it.
02Noncovered codes are not covered for any IHCP program.
03Covered codes are covered subject to limitations established for certain benefit packages.
04For Q4311 through Q4333, the skin-substitute codes in Table 2 are reimbursed at a flat statewide per-unit rate, and Table 1 lists them as allowed for podiatrists (provider specialty 140).
05Table 3 lists the newly covered codes linked to revenue code 636.
06Table 4 lists PA criteria for J1748, J2267, J2470, J2471 and J3247, which refer to the Pharmacy Statewide Uniform Preferred Drug List (SUPDL) accessible from the Pharmacy Services page at in.gov/medicaid/providers.
07For C9901, professional claims require attachment of manufacturer's suggested retail price (MSRP) documentation, or a cost invoice if no MSRP is available.
08J2373 is included in the renal dialysis composite rate.
09Code J0175 is listed with TBD values in the table.
10For codes end-dated in Table 6, use the listed alternate: C9166 with J3247, C9167 with J7171, C9168 with J2267, Q4210 with Q4331 or Q4332, Q4277 with Q4326, and S0164 with J2470.
11Alternate codes do not indicate IHCP coverage, so consult the Professional Fee Schedule for coverage information.
12Q2055 was removed from the code list because it was not a newly added code; its clinical indication, dosage and long description changed, but reimbursement information remained the same.
13Established pricing will be posted on the Professional Fee Schedule and Outpatient Fee Schedule.
14Standard global billing procedures and edits apply to the new codes unless special billing guidance is noted.
15For retroactive claims, managed care claims could be submitted within 90 days and FFS claims within 180 days from the August 1, 2024 publication date to satisfy timely filing.
16These windows are historical, so check current applicability before submitting.
17Include the first page of the bulletin when submitting claims beyond the standard filing limit.
18For FFS PA questions, contact Acentra Health at 866-725-9991.
19For FFS billing and reimbursement questions, contact Gainwell Technologies at 800-457-4584.
20For managed care PA, billing and reimbursement, contact the managed care entity the member is enrolled with.
Codes mentioned
9063790638A9506C1605C1606C9901G0519G0520G0521G0522G0523G0524G0525G0526G0527G0528G0529G0530G0531G9037G9038J0175J0211J0687J0872J0911J1597J1598J1748J2183J2246J2267J2373J2468J2470J2471J3247J3263J3393J3394J7171J7355J8611J8612J9361Q2055Q4311Q4312Q4313Q4314Q4315Q4316Q4317Q4318Q4319Q4320Q4321Q4322Q4323Q4324Q4325Q4326Q4327Q4328Q4329Q4330Q4331Q4332Q4333Q5137Q5138C9113C9166C9167C9168C9787C9790J2780J9371Q4210Q4277S0164
Original notice
BT2024122: Updated coverage and billing information for the 2024 July HCPCS codes
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202497: Coverage information for the July 2024 quarterly HCPCS updateMediumEffective Jul 1, 2024 · Claims & BillingBT202437: Coverage information for the April 2024 quarterly HCPCS updateMediumEffective Apr 1, 2024 · Claims & BillingBT202467: Coverage and billing information for the April 2024 Quarterly HCPCS codes updateHighEffective Apr 1, 2024 · Claims & BillingBT202375: Coverage and billing information for the 2023 July quarterly HCPCS codes updateMediumEffective Jul 1, 2023 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesWound CarePodiatryPharmacyOncologyCardiologyCode 90637Code 90638Code A9506Code C1605Code C1606Code C9901Code G0519Code G0520Code G0521Code G0522Code G0523Code G0524Code G0525Code G0526Code G0527Code G0528Code G0529Code G0530Code G0531Code G9037Code G9038Code J0175Code J0211Code J0687Code J0872Code J0911Code J1597Code J1598Code J1748Code J2183Code J2246Code J2267Code J2373Code J2468Code J2470Code J2471Code J3247Code J3263Code J3393Code J3394Code J7171Code J7355Code J8611Code J8612Code J9361Code Q2055Code Q4311Code Q4312Code Q4313Code Q4314Code Q4315Code Q4316Code Q4317Code Q4318Code Q4319Code Q4320Code Q4321Code Q4322Code Q4323Code Q4324Code Q4325Code Q4326Code Q4327Code Q4328Code Q4329Code Q4330Code Q4331Code Q4332Code Q4333Code Q5137Code Q5138Code C9113Code C9166Code C9167Code C9168Code C9787Code C9790Code J2780Code J9371Code Q4210Code Q4277Code S0164