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Indiana Medicaid (IHCP)Medicaid · Coverage · Medical Policy · IN · Oncology, PathologyMedium impact

BT202362: IHCP adds coverage for plasma-based genomic testing for individuals with advanced solid cancers

Act
by Jul 24, 2023
Effective date
Jul 24, 2023
Identified
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.

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What to do

by Jul 24, 2023 · 4 steps
01Billing team must update system to require prior authorization for CPT codes 0242U and 0326U for Indiana Medicaid patients.
02Configure reimbursement rates: 0242U at $5,000 flat rate, 0326U at 90% of billed charges.
03Use revenue code 310 for institutional claims.
04Set up professional and outpatient facility billing capability for these codes.

Original notice

BT202362: IHCP adds coverage for plasma-based genomic testing for individuals with advanced solid cancers
in.gov · Always check the source before changing claims.
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Related changes

See all Indiana Medicaid (IHCP) changes →
BT2024126: IHCP announces expanded coverage of biomarker testingHighEffective Jul 1, 2024 · Medical PolicyBrowse every Indiana Medicaid (IHCP) change in the policy list

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Indiana Medicaid (IHCP) policiesIN policy changesOncologyPathology

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