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BT202338: IHCP issues reimbursement updates for COVID-19 vaccine administration
Effective date
Jan 1, 2023
Identified
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) updated the rates for COVID-19 vaccine administration codes, effective for dates of service on or after Jan. 1, 2023. The new rate is $38.95 for the listed intramuscular COVID-19 vaccine administration codes and $34.57 for code M0201, COVID-19 vaccine administration inside a patient's home. Professional and outpatient claims with dates of service on or after Jan. 1, 2023 will be mass adjusted, and adjustments will appear on Remittance Advices dated June 7, 2023 with internal control numbers (ICNs) or Claim IDs beginning with 52.
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What to do
Action · 10 steps
01Already effective Jan.
021, 2023: Billing team, for dates of service on or after Jan.
031, 2023, bill the COVID-19 vaccine administration codes at the new rates in Table 1, including M0201 for administration inside a patient's home.
04Watch Remittance Advices dated June 7, 2023 for mass-adjusted claims with ICNs or Claim IDs beginning with 52.
05COVID-19 vaccination reimbursement is carved out of managed care benefits, so send professional and outpatient claims for managed care and fee-for-service members to Gainwell Technologies, and send pharmacy claims for both to Optum Rx.
06Confirm the member meets vaccine Emergency Use Authorization (EUA) criteria and the CDC Advisory Committee on Immunization Practices (ACIP) age and dosing interval recommendations, and any additional requirements of the Indiana Department of Health (IDOH), CDC, or HHS Public Readiness and Emergency Preparedness (PREP) Act.
07Family Supports Waiver (FSW) and Community Integration and Habilitation (CIH) Waiver providers append modifier U7 when billing COVID-19 vaccine and administration codes.
08Pricing will be reflected in the next regular update to the Professional Fee Schedule and Outpatient Fee Schedule.
09Send questions to the FSSA IHCP reimbursement mailbox at FSSA.IHCPReimbursement@fssa.in.gov, and send any communication containing protected health information (PHI) by secure email.
10At this time, the COVID-19 vaccines are still available to providers free of charge, and claims for the vaccine product administered will pay at zero.
Codes mentioned
M0201
Original notice
BT202338: IHCP issues reimbursement updates for COVID-19 vaccine administration
in.gov · Always check the source before changing claims.
Related changes
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