MedicaidPrior AuthHigh impact
BT202452: IHCP to apply PA and preference criteria to FFS physician-administered drugs
Indiana Medicaid (IHCP)·IN · Oncology, Rheumatology, Gastroenterology +4 more·Provider Bulletin
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Starting July 1, 2024, Indiana Medicaid fee-for-service will require prior authorization for 28 physician-administered drugs (mostly oncology, rheumatology, and specialty medications) that previously didn't need PA. All affected drugs must be billed with NDC numbers and specific revenue codes.
Action Required
By June 30, 2024: Billing team must update systems to require prior authorization for all listed procedure codes except J0185 and J1453. Submit PA requests to Acentra Health (866-725-9991) before administering affected drugs. Update billing software to require NDC numbers and link codes to specified revenue codes (mostly 636, some 250/294). Train clinical staff on new PA requirements for high-cost specialty drugs. Claims without proper PA will be denied.