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BT202396: IHCP removes PA requirements for newborn or infant frenectomies
Act
immediately
Effective date
Sep 11, 2023
Identified
Jun 19, 2026
Summary
Effective September 11, 2023, Indiana Health Coverage Programs (IHCP) removed prior authorization requirements for frenectomy procedures (D7961 and D7962) for members ages 0 to 1 year. While PA is no longer required, providers must still establish medical necessity with documentation of significant feeding challenges and photos in the patient file.
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What to do
immediately · 3 steps
01Billing team must update systems to remove prior authorization requirements for CDT codes D7961 and D7962 for patients ages 0-1 year under IHCP/Medicaid.
02Providers must ensure patient files contain referral documentation showing significant feeding challenges and photos to establish medical necessity.
03Limited to 2 units per day per member for reimbursement.
Codes mentioned
D7961D7962
Original notice
BT202396: IHCP removes PA requirements for newborn or infant frenectomies
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202109: Coverage and billing information for the 2021 annual HCPCS codes updateMediumEffective Jan 1, 2021 · Claims & BillingBT202141: IHCP updates FQHC and RHC encounter codesMediumEffective Jul 1, 2021 · Provider BulletinBT2024177: IHCP adds prior authorization requirement for medical and dental frenectomy codesMediumEffective Dec 12, 2024 · Prior AuthorizationBrowse every Indiana Medicaid (IHCP) change in the policy list