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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Orthopedics, Podiatry, Wound Care +17 moreHigh impact

BT202425: Revised coverage and billing information for the 2024 annual HCPCS codes update

Effective date
Jan 1, 2024
Identified
Jun 19, 2026

Summary

Indiana Health Coverage Programs bulletin BT202425, issued February 29, 2024, provides coverage and billing information for the 2024 annual HCPCS update and replaces the information published in bulletin BT2023182. Its tables list new CPT, CDT and HCPCS codes, each marked covered or noncovered by the IHCP, and show which covered codes require prior authorization, which are carved out of managed care, which are reimbursable outside the inpatient DRG, and which are linked to revenue codes 636 and 274. The bulletin also lists codes discontinued in the 2024 annual HCPCS update with alternate code considerations, and it notes that it has been updated, see IHCP Bulletin BT202462.

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What to do

Action · 7 steps
01Already effective Jan.
021, 2024 for dates of service on or after that date, unless otherwise specified: Get prior authorization for the codes that Table 4 lists as requiring it, including CPT 33276, 33277 and 52284, HCPCS C9793, C9794, C9795, J0576, J1412, J1413, J3401, L3161, L5615 and L5926, and meet the criteria in Table 4 for each code.
03Prior authorization is required for all PET scans under C9794, the diagnosis for 52284 must fall under ICD-10 category N35, and every PA request for L3161 must include a written, signed prescription.
04When the basic prosthesis for L5615 or L5926 is approved, its customizing features are exempt from PA.
05Send fee-for-service prior authorization questions to Kepro Customer Service at 866-725-9991 and fee-for-service billing questions to Gainwell Technologies at 800-457-4584, and send managed care questions to the managed care entity the member is enrolled with.
06Codes 96380 and 96381 are allowed for Vaccines for Children when billed with modifier SL.
07Follow the revenue code 636 and 274 linkages in Tables 8 and 9, use the alternate codes in Table 10 in place of end-dated codes, and include a copy of the first page of this bulletin when submitting claims beyond the standard filing limit.

Codes mentioned

332763327752284C9793C9794C9795J0576J1412J1413J3401L3161L5615L59269638096381A9608C9161C9162C9163C9164C9165J0184J0217J0402J1105J1304J1939J279975580E0680E0681K1024K1031C9152C9153C9154C9156C9157C9158C9770K1005K1013K1014K1015K1022K1025K1032K1033S0171

Original notice

BT202425: Revised coverage and billing information for the 2024 annual HCPCS codes update
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT2023182: Coverage and billing information for the 2024 annual HCPCS codes updateMediumEffective Jan 1, 2024 · Claims & BillingBT2023123: Coverage and billing information for the 2023 October HCPCS codes updateMediumEffective Oct 1, 2023 · Claims & BillingBT2023165: Updated coverage and billing information for the 2023 October HCPCS codesMediumEffective Oct 1, 2023 · Claims & BillingBT202467: Coverage and billing information for the April 2024 Quarterly HCPCS codes updateHighEffective Apr 1, 2024 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesOrthopedicsPodiatryWound CareCardiologyOncologyRadiologyPediatricsPsychiatryOphthalmologyDentistryHematologyNephrologyOB-GYNUrologyInfectious DiseaseSleep MedicineNeurosurgeryPulmonologyGastroenterologyPharmacyCode 33276Code 33277Code 52284Code C9793Code C9794Code C9795Code J0576Code J1412Code J1413Code J3401Code L3161Code L5615Code L5926Code 96380Code 96381Code A9608Code C9161Code C9162Code C9163Code C9164Code C9165Code J0184Code J0217Code J0402Code J1105Code J1304Code J1939Code J2799Code 75580Code E0680Code E0681Code K1024Code K1031Code C9152Code C9153Code C9154Code C9156Code C9157Code C9158Code C9770Code K1005Code K1013Code K1014Code K1015Code K1022Code K1025Code K1032Code K1033Code S0171

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