MedicaidPrior AuthHigh impact
BT202335: IHCP updates hysterectomy policy
Indiana Medicaid (IHCP)·IN · OB-GYN·Medical Policy
Effective date
Jun 1, 2023
We identified it
Jun 19, 2026
Summary
Beginning June 1, 2023, Indiana Medicaid (IHCP) is removing their specific hysterectomy qualifying criteria and will instead follow standard InterQual or MCG clinical guidelines for medical necessity determination. This applies to both fee-for-service and managed care authorization reviews.
Action Required
By June 1, 2023: Billing team and providers must ensure hysterectomy prior authorization requests follow InterQual or MCG clinical guidelines instead of previous IHCP-specific criteria from BT201976. Update authorization request templates and documentation requirements to align with standard clinical guidelines. Contact managed care entities to confirm which guideline set (InterQual or MCG) they will use for reviews.