Who is affected by this change?

This affects Indiana Medicaid (IHCP) Cardiology, Cardiothoracic Surgery, Oncology, Radiation Oncology, Orthopedics, Podiatry +12 more providers in IN on Medicaid plans.

When does this change take effect?

This change is effective Jan 1, 2024.

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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Cardiology, Cardiothoracic Surgery, Oncology +15 moreMedium impact

BT2023182: Coverage and billing information for the 2024 annual HCPCS codes update

Q: What do I need to do?

Already effective for dates of service on or after Jan. 1, 2024: Billing team: get prior authorization for the codes that require it (33276, 33277, 52284, C9793, C9794, C9795, D7284, J0576, J1412, J1413, J3401, L3161, L5615 and L5926). Table 4 lists the criteria: 33276 and 33277 point to the Surgical Services provider reference module, and the other codes are listed as To be determined. Send fee-for-service prior authorization questions to Kepro Customer Service at 866-725-9991, and send managed care prior authorization questions to the member's managed care entity. Billing team: check each code's coverage in Table 1 before billing, since codes marked Noncovered are not covered for any program. Attach documentation supporting medical necessity to claims for A6585, A6586, A6587, A6588, E0678, E0679 and E0681. Bill C7903 and G0017 with a limit of one unit per day. Bill with NDC where Table 1 marks NDC required. Several gradient compression and related codes are allowed only for Durable Medical Equipment providers (provider specialty 250), and some are allowed for Home Medical Equipment providers (provider specialty 251). Codes Q4279 through Q4304 are allowed for Podiatrists (provider specialty 140) and are reimbursed at a flat, statewide, per-unit rate. Before billing an alternate code from Table 7, consult the Professional Fee Schedule, since listing an alternate code does not indicate IHCP coverage of it. J1412, J1413 and J3401 are carved out of managed care (Table 5), and J1412 and J1413 are reimbursable outside the inpatient DRG (Table 6). Some codes have their own dates: 96380 and 96381 for dates of service on or after Oct. 6, 2023, and G0011, G0012 and G0013 for dates of service on or after Jan. 2, 2024. Timely filing windows for codes with earlier effective dates were 90 days for managed care and 180 days for fee-for-service claims from the Dec. 28, 2023 publication date. Those windows have elapsed, so check current applicability rather than relying on them.

Q: Which billing codes are affected?

The following codes are affected: 33276, 33277, 52284, C9793, C9794, C9795, D7284, J0576, J1412, J1413, J3401, L3161, L5615, L5926, A6585, A6586, A6587, A6588, E0678, E0679, E0681, C7903, G0017, 96380, 96381, G0011, G0012, G0013.

Effective date

Jan 1, 2024

Identified

Jun 19, 2026

Summary

Indiana Health Coverage Programs (IHCP) covers the newly listed 2024 annual HCPCS update codes for dates of service on or after Jan. 1, 2024, unless otherwise specified, with coverage, prior authorization and NDC requirements set for each code in Table 1. Fourteen of the new codes require prior authorization, including 33276, 33277, 52284, C9793, C9794, C9795, D7284, J0576, J1412, J1413, J3401, L3161, L5615 and L5926, and many other new codes are marked Noncovered for any program. The bulletin states that it is being replaced with IHCP Bulletin BT202425.

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What to do

Action · 18 steps

01Already effective for dates of service on or after Jan.

021, 2024: Billing team: get prior authorization for the codes that require it (33276, 33277, 52284, C9793, C9794, C9795, D7284, J0576, J1412, J1413, J3401, L3161, L5615 and L5926).

03Table 4 lists the criteria: 33276 and 33277 point to the Surgical Services provider reference module, and the other codes are listed as To be determined.

04Send fee-for-service prior authorization questions to Kepro Customer Service at 866-725-9991, and send managed care prior authorization questions to the member's managed care entity.

05Billing team: check each code's coverage in Table 1 before billing, since codes marked Noncovered are not covered for any program.

06Attach documentation supporting medical necessity to claims for A6585, A6586, A6587, A6588, E0678, E0679 and E0681.

07Bill C7903 and G0017 with a limit of one unit per day.

08Bill with NDC where Table 1 marks NDC required.

09Several gradient compression and related codes are allowed only for Durable Medical Equipment providers (provider specialty 250), and some are allowed for Home Medical Equipment providers (provider specialty 251).

10Codes Q4279 through Q4304 are allowed for Podiatrists (provider specialty 140) and are reimbursed at a flat, statewide, per-unit rate.

11Before billing an alternate code from Table 7, consult the Professional Fee Schedule, since listing an alternate code does not indicate IHCP coverage of it.

12J1412, J1413 and J3401 are carved out of managed care (Table 5), and J1412 and J1413 are reimbursable outside the inpatient DRG (Table 6).

13Some codes have their own dates: 96380 and 96381 for dates of service on or after Oct.

146, 2023, and G0011, G0012 and G0013 for dates of service on or after Jan.

152, 2024.

16Timely filing windows for codes with earlier effective dates were 90 days for managed care and 180 days for fee-for-service claims from the Dec.

1728, 2023 publication date.

18Those windows have elapsed, so check current applicability rather than relying on them.

Codes mentioned

332763327752284C9793C9794C9795D7284J0576J1412J1413J3401L3161L5615L5926A6585A6586A6587A6588E0678E0679E0681C7903G00179638096381G0011G0012G0013

Original notice

BT2023182: Coverage and billing information for the 2024 annual HCPCS codes update

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

View original ↗

BT202425: Revised coverage and billing information for the 2024 annual HCPCS codes updateHighEffective Jan 1, 2024 · Claims & Billing BT202487: IHCP updates FQHC and RHC encounter codesMediumEffective Jul 22, 2024 · Provider Bulletin BT202476: IHCP updates HIP preventive care services exempt from copaymentHighEffective Jul 1, 2024 · Managed Care BT2024114: IHCP corrects DME pricingMediumEffective Jan 1, 2024 · Provider Bulletin Browse every Indiana Medicaid (IHCP) change in the policy list

BT2023182: Coverage and billing information for the 2024 annual HCPCS codes update

Summary

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What to do

Codes mentioned

Original notice

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