MedicaidCoverageMedium impact
BT2023159: IHCP adds coverage for RSV vaccine Abrysvo
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, OB-GYN +2 more·Medical Policy
Effective date
May 31, 2023
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) now covers RSV vaccine Abrysvo (CPT 90678) for adults 60+ effective May 31, 2023, and for pregnant patients at 32-36 weeks gestation effective August 21, 2023. Maximum reimbursement is $309.75 with no prior authorization required.
Action Required
Immediately: Billing team should verify CPT 90678 is active in system for RSV vaccine Abrysvo with $309.75 max fee. Ensure age restrictions (60+ years) and pregnancy criteria (32-36 weeks gestation) are documented. Watch for mass-adjusted claims with ICNs beginning with 80 or 52 on remittance advices starting December 20, 2023. Update encounter forms to reflect no prior authorization or NDC requirements for eligible patients.