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BT2023165: Updated coverage and billing information for the 2023 October HCPCS codes
Effective date
Oct 1, 2023
Identified
Jun 19, 2026
Summary
Codes added in the October 2023 quarterly HCPCS update have Indiana Medicaid (IHCP) coverage, prior authorization, NDC and billing rules, effective for dates of service on or after October 1, 2023 unless otherwise specified. This update replaces the coverage and billing information issued earlier for the same HCPCS update. The COVID-19 vaccine and vaccine administration codes are effective for dates of service on or after September 11, 2023, and they are carved out of managed care.
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What to do
Action · 14 steps
01Already effective October 1, 2023 for dates of service on or after that date, unless otherwise noted: Billing team: For each code in Table 1, bill using the program coverage, prior authorization required, NDC required and special billing information listed for that code.
02Codes marked Noncovered are not covered by the IHCP for any program.
03For PA requests, use the criteria in Table 6.
04For B4148 and L1681, PA requests must include a written, signed prescription, as described in the Durable and Home Medicaid Equipment and Supplies provider reference module.
05For L5991, prosthetic devices require PA for medical necessity, and when the basic prosthesis is approved, all customizing features are exempt from PA.
06For C9791, radiology services must be ordered in writing, and the IHCP requires PA for radiology services that exceed the parameters in the Radiology Services provider reference module.
07For C9154, the criteria require the member to be 18 years of age or older, documented failure of each preferred agent on the pharmacy Preferred Drug List or a prescriber's member-specific medically justifiable reason, and doses that do not exceed 32 mg/week or 128 mg/month.
08FQHC and RHC billing team: Bill the COVID-19 vaccine administration code as fee-for-service using place of service code 71, without a T1015 encounter code.
09VFC billing: Bill COVID-19 vaccine and administration claims directly to Medicaid as fee-for-service claims using the SL modifier.
10Waiver providers listed in the bulletin bill COVID-19 vaccine and administration codes with modifier U7.
11Claims for IHCP members who are dually eligible for Medicare and Medicaid for COVID-19 vaccination must be billed to the member's Medicare plan provider.
12Table 8 DME and supply codes are included in the LTC facility per diem rate.
13Historical timely filing windows: this bulletin gave 90 days from publication for managed care claims and 180 days from publication for fee-for-service claims to bypass timely filing limits, and providers should include the first page of the bulletin when submitting claims beyond the standard filing limit.
14Check current applicability before relying on this notice.
Codes mentioned
904809131891319913209132191322A2022A2023A2024A2025A9156A9268A9269A9292A9573A9603A9697B4148C9151C9152C9153C9154C9155C9156C9157C9158C9788C9789C9790C9791C9792E0490E0491H2040H2041J0349J0800J0801J0802J0874J0889J2359J2781J7214J7353J7519J9051J9064J9345K1036L1681L5991Q4285Q4286
Original notice
BT2023165: Updated coverage and billing information for the 2023 October HCPCS codes
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT2023123: Coverage and billing information for the 2023 October HCPCS codes updateMediumEffective Oct 1, 2023 · Claims & BillingBT2026182: COVID-19 vaccine administration to no longer be carved out of managed careHighEffective Jan 1, 2027 · Provider BulletinBT2023179: Coverage removed for Pfizer and Moderna COVID-19 vaccination codes; replacement codes providedMediumEffective Nov 1, 2023 · Medical PolicyBT202419: IHCP mass adjusts or reprocesses claims for COVID-19 vaccine and administration codesMediumEffective Sep 11, 2023 · Provider BulletinBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesPodiatryWound CareOncologyOrthopedicsPharmacyCode 90480Code 91318Code 91319Code 91320Code 91321Code 91322Code A2022Code A2023Code A2024Code A2025Code A9156Code A9268Code A9269Code A9292Code A9573Code A9603Code A9697Code B4148Code C9151Code C9152Code C9153Code C9154Code C9155Code C9156Code C9157Code C9158Code C9788Code C9789Code C9790Code C9791Code C9792Code E0490Code E0491Code H2040Code H2041Code J0349Code J0800Code J0801Code J0802Code J0874Code J0889Code J2359Code J2781Code J7214Code J7353Code J7519Code J9051Code J9064Code J9345Code K1036Code L1681Code L5991Code Q4285Code Q4286