When does this change take effect?

This change is effective Jul 1, 2024.

What do I need to do?

Effective July 1, 2024 for dates of service on or after that date: Billing team should check HIP preventive care claims against Table 1, which lists the procedure codes that qualify for the copayment exemption, and against Table 2, which lists codes no longer included as exempt from copay. Copays will once again be assessed, because the public health emergency has concluded. Exempt services are not deducted from Personal Wellness and Responsibility (POWER) Accounts for members in any HIP category. Where a code is marked Y in the diagnosis code match required column, the diagnosis code on the claim must match. Including a code on these tables does not necessarily indicate coverage, so providers should check with the member's managed care entity (MCE) to determine whether the service is covered for that member. The code table no longer applies to members in Presumptive Eligibility (PE) Adult, because copayments will not be resuming for PE Adult. Historical: IHCP stated it would continue the pause on copayments for COVID-19 testing or treatments until Oct. 1, 2024, so check current applicability for that date. Questions about this publication go to Customer Assistance at 800-457-4584.

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Indiana Medicaid (IHCP)Medicaid · Coverage · Managed Care · IN · General Practice, Internal Medicine, Pediatrics +1 moreHigh impact

BT202476: IHCP updates HIP preventive care services exempt from copayment

Q: Who is affected by this change?

This affects Indiana Medicaid (IHCP) General Practice, Internal Medicine, Pediatrics, OB-GYN providers in IN on Medicaid plans.

Effective date

Jul 1, 2024

Identified

Jun 19, 2026

Summary

Effective July 1, 2024, the Indiana Health Coverage Programs (IHCP) updated the procedure codes for Healthy Indiana Plan (HIP) preventive care services that are exempt from copayment, now that the public health emergency has concluded. Table 1 lists codes that qualify for the copayment exemption for HIP Basic, HIP State Plan Basic and HIP State Plan Plus Copay members. Table 2 lists codes that are no longer included as exempt, and copays will once again be assessed. Exempt services are also not deducted from Personal Wellness and Responsibility (POWER) Accounts for members in any HIP category.

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What to do

Action · 9 steps

01Effective July 1, 2024 for dates of service on or after that date: Billing team should check HIP preventive care claims against Table 1, which lists the procedure codes that qualify for the copayment exemption, and against Table 2, which lists codes no longer included as exempt from copay.

02Copays will once again be assessed, because the public health emergency has concluded.

03Exempt services are not deducted from Personal Wellness and Responsibility (POWER) Accounts for members in any HIP category.

04Where a code is marked Y in the diagnosis code match required column, the diagnosis code on the claim must match.

05Including a code on these tables does not necessarily indicate coverage, so providers should check with the member's managed care entity (MCE) to determine whether the service is covered for that member.

06The code table no longer applies to members in Presumptive Eligibility (PE) Adult, because copayments will not be resuming for PE Adult.

07Historical: IHCP stated it would continue the pause on copayments for COVID-19 testing or treatments until Oct.

081, 2024, so check current applicability for that date.

09Questions about this publication go to Customer Assistance at 800-457-4584.

Codes mentioned

00812008133641036415364164533145333453344533845346453804538145382453844538545388767757706377067770787708077081770857708678350783518005580061800818100081001810028100381007811628116381164811658116681167812128121581216812178227082274824658294783036836558371883719837218372284152841538415484478850048500986328864818658086592866318663286689867018670286703867698678086803869018708187084870868708887110872708732087340874268742887485874908749187492875348753787590875918759287593876358763687637878108781187850879138814188142881438814788148881508815288153881558816488165881668816788174881759046090461904719047290473904749048090611906209062190622906309063290633906349063690644906479064890649906509065190653906549065590656906579065890660906619066290670906719067290673906749067790680906829068590686906879068890697906989070790710907139071490715907169072390732907339073490736907399074090743907449074690747907489075090756907599130491318913199132091321913229200492012920149255192552925589476096040990009900199385993869939599396994019940299403994049940699407994089940999459G0011G0013G0101G0102G0103G0104G0105G0106G0120G0121G0123G0124G0141G0143G0144G0145G0147G0148G0310G0311G0312G0313G0314G0315G0396G0397G0402G0432G0433G0435G0442G0443G0444G0445G0447G2025M0224M0240M0241M0243M0245Q0091Q0224Q0240Q0245S0613U0001U000245330453784539171045710467677077065770668007480076820438204482948830208302184030842028420384436844378443984443845208500785013850148501885025850278688087275872768727987280874008742087501875028750387631876328763387634878048780790678906799069690700907029200292567925869258796150963809638197802978039780499155991569915799202992039920499205992119921299281992829928399284992859930499305993069930799308993099931099341993429934499345993479934899349993509938199382993839938499391993929939399394994419944299443G0071G0270G0271G0438G0439G0446G2010G2012S9470

Original notice

BT202476: IHCP updates HIP preventive care services exempt from copayment

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

View original ↗

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BT202476: IHCP updates HIP preventive care services exempt from copayment

Summary

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What to do

Codes mentioned

Original notice

Related changes

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