MedicaidPrior AuthMedium impact
BT202396: IHCP removes PA requirements for newborn or infant frenectomies
Indiana Medicaid (IHCP)·IN · Dentistry, Oral & Maxillofacial Surgery, Pediatrics·Provider Bulletin
Effective date
Sep 11, 2023
We identified it
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.
Action Required
Immediately: Billing team must update systems to remove prior authorization requirements for CDT codes D7961 and D7962 for patients ages 0-1 year under IHCP/Medicaid. Providers must ensure patient files contain referral documentation showing significant feeding challenges and photos to establish medical necessity. Limited to 2 units per day per member for reimbursement.