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BT202467: Coverage and billing information for the April 2024 Quarterly HCPCS codes update
Effective date
Apr 1, 2024
Identified
Jun 19, 2026
Summary
The Indiana Health Coverage Programs (IHCP) published coverage and billing information for the April 2024 quarterly HCPCS update, replacing bulletin BT202437. Many of the new codes are covered, several of those require prior authorization, and others are noncovered for all IHCP programs. The bulletin also lists skin-substitute codes paid at a flat statewide per-unit rate, codes linked to revenue codes 274 and 636, and alternate codes for codes that were end-dated.
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What to do
Action · 15 steps
01Already effective for dates of service on or after April 1, 2024, unless otherwise specified: Billing team should check the Covered or Noncovered status of each code in Table 1 before billing it, because noncovered codes are not covered for any IHCP program.
02Where the Table 1 PA column is Yes, get prior authorization using the criteria in Table 5.
03Opioid use disorder agents C9166, C9168, J0577 and J0578 follow the PA criteria on the Optum Rx Indiana Medicaid website.
04E0468 follows the PA criteria in the Durable and Home Medical Equipment and Supplies provider reference module.
05L1320 requires PA for medical necessity.
06For L5783 and L5841, PA is required for medical necessity, and customizing features are exempt from PA when the basic prosthesis is approved.
07For B4148, every PA request must include a written, signed prescription, and the DME supplier must complete the Durable Medical Equipment Information Form for Enteral and Parenteral Nutrition and keep it on file with the patient's medical records, along with a physician's signed order.
08L1320, L5783 and L5841 are allowed for DME providers (provider specialty 250) and are not allowed for Home Medical Equipment providers (provider specialty 251).
09Use the alternate codes listed in Table 8 in place of end-dated codes.
10Codes in Table 3 are linked to revenue code 274, and codes in Table 4 are linked to revenue code 636.
11For retroactive claims, managed care claims could be submitted within 90 days from the May 21, 2024 publication date and FFS claims within 180 days, to satisfy timely filing.
12These windows are historical, so check current applicability before submitting.
13Include the first page of the bulletin when submitting claims beyond the standard filing limit.
14For FFS billing and reimbursement questions, contact Gainwell Technologies at 800-457-4584.
15For FFS PA questions, contact Acentra Health at 866-725-9991.
Codes mentioned
A2026A4271A4438A4564A4593A4594A9293C9166C9167C9168C9796C9797E0152E0468E0736E0738E0739E2104E2298G0138H0051J0177J0209J0577J0578J0589J0650J0651J0652J1010J1202J1203J1323J1434J2277J2782J2801J2919J3055J3424J7165J7354J9073J9074J9075J9248J9249J9376K1037L1320L5783L5841M0224Q0224Q4305Q4306Q4307Q4308Q4309Q4310Q5133Q5134S4988S9002B4148C9159C9161C9162C9163C9164C9165J0576J1020J1030J1040J2920J2930J9070J9250J9260Q4244
Original notice
BT202467: Coverage and billing information for the April 2024 Quarterly HCPCS codes update
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202437: Coverage information for the April 2024 quarterly HCPCS updateMediumEffective Apr 1, 2024 · Claims & BillingBT202425: Revised coverage and billing information for the 2024 annual HCPCS codes updateHighEffective Jan 1, 2024 · Claims & BillingBT2024213: IHCP announces updates to pricing and coverage for certain HCPCS codesMediumEffective Dec 31, 2024 · Claims & BillingBT2024122: Updated coverage and billing information for the 2024 July HCPCS codesHighEffective Jul 1, 2024 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list
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