MedicaidCoverageMedium impact
BT2023152: Radiodiagnostic agents newly covered; PA removed for Pylarify
Indiana Medicaid (IHCP)·IN · Nuclear Medicine, Radiology, Urology +1 more·Provider Bulletin
Effective date
Dec 11, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid will cover two new radiodiagnostic agents (A9596 and A9800) for prostate cancer PET imaging effective December 11, 2023, and is removing prior authorization requirements for Pylarify (A9595). All three agents can now be billed without prior authorization.
Action Required
By December 11, 2023: Billing team must add new HCPCS codes A9596 ($987.00 max fee) and A9800 ($865.20 max fee) to billing system for prostate cancer PET imaging. Remove prior authorization requirements for A9595 (Pylarify). Configure all three codes to bill with revenue code 636 in outpatient settings. Update fee schedules with maximum reimbursement amounts.