MedicaidPrior AuthHigh impact
BT202295: IHCP updates prenatal tests and screening policies
Indiana Medicaid (IHCP)·IN · OB-GYN, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Dec 1, 2022
We identified it
Jun 19, 2026
Summary
Effective December 1, 2022, Indiana Health Coverage Programs (IHCP/Medicaid) will cover cell-free DNA prenatal screenings and carrier screenings for cystic fibrosis, spinal muscular atrophy, and hemoglobinopathies without prior authorization. Only one screening per pregnancy/lifetime per member is allowed for these genetic tests.
Action Required
By December 1, 2022: Billing team must update system to remove prior authorization requirements for CPT codes 81420, 81507, 81220, 81329, and 81361 for Indiana Medicaid patients. Update encounter forms and billing software to enforce unit limitations: one screening per pregnancy for prenatal tests (81420, 81507) and one screening per lifetime for carrier screenings (81220, 81329, 81361). Verify eligibility includes pregnant women and individuals of reproductive age.