MedicaidCoverageMedium impact
BT202362: IHCP adds coverage for plasma-based genomic testing for individuals with advanced solid cancers
Indiana Medicaid (IHCP)·IN · Oncology, Pathology·Medical Policy
Effective date
Jul 24, 2023
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) will cover two plasma-based genomic tests for advanced solid cancers starting July 24, 2023. Both tests require prior authorization and have specific reimbursement rates.
Action Required
By July 24, 2023: Billing team must update system to require prior authorization for CPT codes 0242U and 0326U for Indiana Medicaid patients. Configure reimbursement rates: 0242U at $5,000 flat rate, 0326U at 90% of billed charges. Use revenue code 310 for institutional claims. Set up professional and outpatient facility billing capability for these codes.