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BT2024102: IHCP updates PA criteria for HCPCS codes Q2054 (Breyanzi) and Q2055 (Abecma)
Act
immediately
Effective date
Mar 15, 2024
Identified
Jun 19, 2026
Summary
IHCP has updated prior authorization criteria for CAR-T cell therapies Breyanzi (Q2054) and Abecma (Q2055), adding specific eligibility requirements including age restrictions, diagnosis criteria, prior treatment history, and facility certification requirements. These therapies are carved out from managed care and processed through fee-for-service delivery.
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What to do
immediately · 4 steps
01Review updated PA criteria for Q2054 (Breyanzi) and Q2055 (Abecma).
02Ensure all PA requests include documentation of age 18+, specific diagnosis codes, prior treatment history, and REMS-certified facility administration.
03Submit all PA requests to Acentra Health at 866-725-9991, not managed care entities.
04Claims must be submitted to Gainwell Technologies FFS system.
Codes mentioned
Q2054Q2055
Original notice
BT2024102: IHCP updates PA criteria for HCPCS codes Q2054 (Breyanzi) and Q2055 (Abecma)
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202551: IHCP updates PA criteria for CAR-T therapiesMediumEffective Jun 26, 2024 · Provider BulletinBT202190: Coverage and billing information for the October 2021 HCPCS code updateMediumEffective Oct 1, 2021 · Claims & BillingBT2021113: Coverage and billing information for the 2022 annual HCPCS codes updateMediumEffective Jan 1, 2022 · Claims & BillingBT202497: Coverage information for the July 2024 quarterly HCPCS updateMediumEffective Jul 1, 2024 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list