MedicaidPrior AuthMedium impact
BT202317: IHCP updates specified genetic testing policies
Indiana Medicaid (IHCP)·IN · Oncology, OB-GYN·Provider Bulletin
Effective date
Apr 7, 2023
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) is updating prior authorization criteria for two genetic testing policies effective April 7, 2023. The Oncotype DX Breast Recurrence Score test will now include all pN1 pathological node stages, and PALB2 genetic testing will use the same PA criteria as BRCA1/BRCA2 testing.
Action Required
By April 7, 2023: Billing team must update prior authorization protocols for genetic testing codes 81519, 81522, and 81307. For codes 81519 and 81522, expand PA criteria to include all pN1 pathological node stages (pN1a, pN1b, pN1c) instead of just pN0 or pN1mi. For code 81307 (PALB2), apply the same medical necessity criteria used for BRCA1/BRCA2 testing. Review Genetic Testing provider reference module for complete criteria. Contact Gainwell Technologies at 800-457-4584 for questions about FFS billing.