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BT202328: Coverage and billing information for the 2023 April quarterly HCPCS codes update
Effective date
Apr 1, 2023
Identified
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) coverage and billing information for the 2023 April quarterly HCPCS update is effective for dates of service on or after April 1, 2023. The update adds new codes, including C9149 (teplizumab) with prior authorization criteria, and skin-substitute codes A2019, A2021 and Q4265 through Q4271 that are reimbursed at a flat, statewide, per-unit rate. It also adds new procedure code modifiers JK, JL, LU, N1, N2 and N3, and new long-term care (LTC) durable medical equipment and supply codes that are included in the LTC facility per diem rate.
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What to do
Action · 8 steps
01Already effective April 1, 2023: Billing team, for dates of service on or after April 1, 2023, bill the new codes with the standard global billing procedures and edits, unless special billing guidance is noted for a code.
02For C9149, obtain prior authorization for members who meet all of the following: age 8 years or older; a diagnosis of Stage 2 type 1 diabetes (T1D) with documentation of at least two of the listed pancreatic islet cell autoantibodies and dysglycemia without overt hyperglycemia using an oral glucose tolerance test (OGTT) or an alternative method, and no patient history suggesting type 2 diabetes; documentation of a complete blood count (CBC) and liver enzyme tests within the past 30 days; documentation of a negative pregnancy test within the past 30 days; and prescription by or in consultation with an endocrinologist.
03Bill A2019, A2021 and Q4265 through Q4271 for podiatrists (provider specialty 140), and bill the codes listed in Table 6 with revenue code 636.
04Bill A4341, A4342, A6590, A6591 and E0677 for DME providers (provider specialty 250), and E0677 also for home medical equipment providers (provider specialty 251).
05Use the Professional Fee Schedule and Outpatient Fee Schedule, accessible from the IHCP Fee Schedules page at in.gov/medicaid/providers, for pricing, since some new codes show pricing to be determined.
06Send fee-for-service reimbursement, prior authorization and billing questions to Gainwell Technologies at 800-457-4584, and send managed care questions to the managed care entity the member is enrolled with.
07Managed care claims have 90 days and fee-for-service claims have 180 days from the date of this publication to meet timely filing requirements.
08When submitting claims beyond the standard filing limit, include a copy of this bulletin (first page only).
Codes mentioned
A2019A2020A2021A4341A4342A4560A6590A6591A7049C9145C9146C9147C9148C9149E0677E0711E1905J0208J0218J0612J0613J1411J1449J1747J2403J9196J9294J9296J9297K1035L8678M0010Q4265Q4266Q4267Q4268Q4269Q4270Q4271Q5127Q5128Q5129Q5130S9563
Original notice
BT202328: Coverage and billing information for the 2023 April quarterly HCPCS codes update
in.gov · Always check the source before changing claims.
Related changes
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Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesEndocrinologyPodiatryWound CareOncologyGastroenterologyNephrologyUrologyGeriatricsCode A2019Code A2020Code A2021Code A4341Code A4342Code A4560Code A6590Code A6591Code A7049Code C9145Code C9146Code C9147Code C9148Code C9149Code E0677Code E0711Code E1905Code J0208Code J0218Code J0612Code J0613Code J1411Code J1449Code J1747Code J2403Code J9196Code J9294Code J9296Code J9297Code K1035Code L8678Code M0010Code Q4265Code Q4266Code Q4267Code Q4268Code Q4269Code Q4270Code Q4271Code Q5127Code Q5128Code Q5129Code Q5130Code S9563