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BT202375: Coverage and billing information for the 2023 July quarterly HCPCS codes update
Effective date
Jul 1, 2023
Identified
Jun 19, 2026
Summary
The Indiana Health Coverage Programs set coverage and billing rules for the 2023 July quarterly HCPCS update, effective for dates of service on or after July 1, 2023. Table 1 lists new CPT and HCPCS codes with their Indiana Medicaid coverage status, and codes marked Noncovered are not covered for any program. Several new codes are covered and need prior authorization or NDC reporting, and pricing for these codes is still to be determined. Skin-substitute codes Q4272 through Q4284 are paid at a flat statewide per-unit rate, and some codes are linked to revenue code 636, carved out of managed care, or included in the renal dialysis composite rate.
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What to do
Action · 13 steps
01Already effective July 1, 2023 for dates of service on or after that date: Billing team: bill the new codes under the standard global billing procedures and edits, unless the table gives special billing guidance.
02Do not expect IHCP coverage for codes marked Noncovered in Table 1, because the IHCP does not cover those services for any programs.
03Get prior authorization before billing J1811, J1812, J1813, J1814, J2329 and J9381, which require it.
04For J9381 (teplizumab-mzwv), the member must be 8 years of age or older, have a Stage 2 type 1 diabetes diagnosis documented with at least two of the listed pancreatic islet cell autoantibodies and dysglycemia without overt hyperglycemia, have no history suggesting type 2 diabetes, have a CBC and liver enzyme tests documented within the past 30 days, have a negative pregnancy test documented within the past 30 days, and be prescribed by or in consultation with an endocrinologist.
05Report NDC for the J codes marked Yes in the NDC column.
06Bill skin-substitute codes Q4272 through Q4284 at the flat statewide per-unit rate and as the table indicates for podiatrists (provider specialty 140) and revenue code 636.
07Ambulance providers (provider specialty 260) may bill J2329, J2371 and J2372 as listed.
08Bill J7213 as a code carved out of managed care and separately reimbursable outside the inpatient DRG.
09Use the alternate codes in Table 7 for end-dated codes C9146, C9148 and C9149.
10Pricing for the new codes is to be determined, and the IHCP will issue a separate publication with pricing after final calculations.
11Direct fee-for-service billing questions to Gainwell Technologies at 800-457-4584, and direct fee-for-service prior authorization questions to Kepro Customer Service at 866-725-9991.
12Managed care reimbursement, prior authorization and billing questions go to the managed care entity in which the member is enrolled.
13The bulletin notes that procedure code J9321 was removed from Table 1.
Codes mentioned
C9150C9151C9784C9785C9786C9787J0137J0206J0216J0457J0665J0736J0737J1440J1576J1805J1806J1811J1812J1813J1814J1836J1920J1921J1941J1961J2249J2305J2329J2371J2372J2427J2561J2598J2599J2806J7213J9029J9056J9058J9059J9063J9259J9322J9323J9347J9350J9380J9381Q4272Q4273Q4274Q4275Q4276Q4277Q4278Q4280Q4281Q4282Q4283Q4284Q5131C9146C9148C9149
Original notice
BT202375: Coverage and billing information for the 2023 July quarterly HCPCS codes update
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202382: Additional updates made to the July 2023 quarterly HCPCS code updateMediumEffective Jul 1, 2023 · Claims & BillingBT202328: Coverage and billing information for the 2023 April quarterly HCPCS codes updateMediumEffective Apr 1, 2023 · Claims & BillingBT2024122: Updated coverage and billing information for the 2024 July HCPCS codesHighEffective Jul 1, 2024 · Claims & BillingBT2023123: Coverage and billing information for the 2023 October HCPCS codes updateMediumEffective Oct 1, 2023 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesPodiatryWound CareCardiologyOncologyEndocrinologyNephrologyOphthalmologyNeurologyEmergency MedicineOrthopedicsCode C9150Code C9151Code C9784Code C9785Code C9786Code C9787Code J0137Code J0206Code J0216Code J0457Code J0665Code J0736Code J0737Code J1440Code J1576Code J1805Code J1806Code J1811Code J1812Code J1813Code J1814Code J1836Code J1920Code J1921Code J1941Code J1961Code J2249Code J2305Code J2329Code J2371Code J2372Code J2427Code J2561Code J2598Code J2599Code J2806Code J7213Code J9029Code J9056Code J9058Code J9059Code J9063Code J9259Code J9322Code J9323Code J9347Code J9350Code J9380Code J9381Code Q4272Code Q4273Code Q4274Code Q4275Code Q4276Code Q4277Code Q4278Code Q4280Code Q4281Code Q4282Code Q4283Code Q4284Code Q5131Code C9146Code C9148Code C9149