MedicaidPrior AuthMedium impact
BT2023114: IHCP summarizes billing guidelines for diabetes testing supplies
Indiana Medicaid (IHCP)·IN · Endocrinology, Family Medicine, Internal Medicine·Claims & Billing
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) clarified billing guidelines for diabetes testing supplies, eliminating prior authorization requirements for preferred CGM products effective January 1, 2023, while maintaining PA requirements for non-preferred products. Professional claims must include 11-digit NDC or UDI codes for all diabetes testing supplies.
Action Required
Immediately: Billing team must verify that claims for diabetes testing supplies (CGM and SBGM) include required 11-digit National Drug Code (NDC) or unique device identifier (UDI) in billing system. Update claim submission processes to ensure preferred diabetes products from PDSL do not require prior authorization, while non-preferred products still need PA with medical necessity documentation. Pharmacy providers must submit all diabetes supply claims via point-of-sale (POS) system.