Who is affected by this change?

This affects Indiana Medicaid (IHCP) Oncology, Dentistry, Ophthalmology, Cardiology, Endocrinology, Pulmonology +3 more providers in IN on Medicaid plans.

When does this change take effect?

This change is effective Jul 1, 2022.

What do I need to do?

Already effective 2022-07-01: For codes with an earlier effective date, managed care claims had 90 days from the bulletin publication and FFS claims had 180 days from publication to meet timely filing requirements. That window is historical, so check current applicability before billing these codes. When submitting a claim beyond the standard filing limit, include a copy of the first page of this bulletin. Billing team: get prior authorization for C9098, G0308, G0309, J1306 and J2356 when the criteria in Table 5 are met. Report a National Drug Code on claims for codes marked NDC required in Table 1. Do not bill codes marked Noncovered in Table 1 to IHCP, because IHCP does not cover them for any programs. Use the alternate codes in Table 9 in place of the end-dated codes: J2998 for C9090, J9331 for C9091, J3299 for C9092 and J2779 for C9093. Dental vaccine administration codes D1708 through D1712 are restricted to dentists (provider type 27) for patients 12 years and older, D1713 and D1714 are restricted to dentists for ages 5 to 11, and they are reimbursed at 90% of the amount billed on dental claims. Codes 87913 and Q4259 through Q4261 are allowed for podiatrists (provider specialty 140). Codes 87913 and 0074A are copay exempt for HIP and Presumptive Eligibility adult members. G9678 payments may only be made to OCM practitioners for OCM beneficiaries. Codes in Table 6 are carved out of managed care, and C9098 is reimbursable outside the inpatient DRG. For FFS questions about reimbursement, PA and billing, contact Gainwell Technologies at 800-457-4584. For managed care questions, contact the managed care entity the member is enrolled with.

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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Oncology, Dentistry, Ophthalmology +6 moreMedium impact

BT202251: Coverage and billing information for the July 2022 quarterly HCPCS codes update

Q: Which billing codes are affected?

The following codes are affected: 87913, 90584, 91308, 91310, 91311, A9596, A9601, C9090, C9091, C9092, C9093, C9094, C9095, C9096, C9097, C9098, D1708, D1709, D1710, D1711, D1712, D1713, D1714, G0308, G0309, G9678, J0739, J1306, J1551, J2356, J2779, J2998, J3299, J9331, J9332, K1034, Q4259, Q4260, Q4261.

Effective date

Jul 1, 2022

Identified

Jun 19, 2026

Summary

The IHCP added new CPT, CDT and HCPCS procedure codes from the July 2022 quarterly HCPCS update, effective for dates of service on or after July 1, 2022, unless otherwise specified. Each new code carries its own coverage, prior authorization, NDC and special billing status, and some codes are noncovered for all programs. The update also lists alternate codes to use in place of four codes that have been end-dated.

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What to do

Action · 14 steps

01Already effective 2022-07-01: For codes with an earlier effective date, managed care claims had 90 days from the bulletin publication and FFS claims had 180 days from publication to meet timely filing requirements.

02That window is historical, so check current applicability before billing these codes.

03When submitting a claim beyond the standard filing limit, include a copy of the first page of this bulletin.

04Billing team: get prior authorization for C9098, G0308, G0309, J1306 and J2356 when the criteria in Table 5 are met.

05Report a National Drug Code on claims for codes marked NDC required in Table 1.

06Do not bill codes marked Noncovered in Table 1 to IHCP, because IHCP does not cover them for any programs.

07Use the alternate codes in Table 9 in place of the end-dated codes: J2998 for C9090, J9331 for C9091, J3299 for C9092 and J2779 for C9093.

08Dental vaccine administration codes D1708 through D1712 are restricted to dentists (provider type 27) for patients 12 years and older, D1713 and D1714 are restricted to dentists for ages 5 to 11, and they are reimbursed at 90% of the amount billed on dental claims.

09Codes 87913 and Q4259 through Q4261 are allowed for podiatrists (provider specialty 140).

10Codes 87913 and 0074A are copay exempt for HIP and Presumptive Eligibility adult members.

11G9678 payments may only be made to OCM practitioners for OCM beneficiaries.

12Codes in Table 6 are carved out of managed care, and C9098 is reimbursable outside the inpatient DRG.

13For FFS questions about reimbursement, PA and billing, contact Gainwell Technologies at 800-457-4584.

14For managed care questions, contact the managed care entity the member is enrolled with.

Codes mentioned

8791390584913089131091311A9596A9601C9090C9091C9092C9093C9094C9095C9096C9097C9098D1708D1709D1710D1711D1712D1713D1714G0308G0309G9678J0739J1306J1551J2356J2779J2998J3299J9331J9332K1034Q4259Q4260Q4261

Original notice

BT202251: Coverage and billing information for the July 2022 quarterly HCPCS codes update

in.gov · Always check the source before changing claims.

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BT202691: IHCP no longer covers COVID‑19 vaccination codes for dental providersMediumEffective Oct 1, 2024 · Specialty Services BT202285: Coverage and billing information for the 2022 October quarterly HCPCS codes updateMediumEffective Oct 1, 2022 · Claims & Billing BT202262: IHCP to cover COVID-19 vaccine for children as young as age 6 monthsMediumEffective Jun 17, 2022 · Provider Bulletin BT202227: Coverage and billing information for the April 2022 quarterly HCPCS code updateMediumEffective Apr 1, 2022 · Claims & Billing Browse every Indiana Medicaid (IHCP) change in the policy list

BT202251: Coverage and billing information for the July 2022 quarterly HCPCS codes update

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

Original notice

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