MedicaidPrior AuthMedium impact
BT202244: IHCP updates PA criteria for HCPCS code Q2042 (Kymriah)
Indiana Medicaid (IHCP)·IN · Oncology, Hematology·Claims & Billing
Effective date
Jun 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for HCPCS code Q2042 (Kymriah CAR-T therapy) to include coverage for relapsed or refractory follicular lymphoma in adults after two or more lines of systemic therapy. This expands the existing coverage criteria which previously covered certain leukemia and large B-cell lymphoma cases.
Action Required
For providers treating Indiana Medicaid patients: Update prior authorization requests for HCPCS code Q2042 to include the new coverage criteria for relapsed or refractory follicular lymphoma in adults 18+ after two or more systemic therapy lines. Ensure facility is REMS Program-certified and providers have completed CAR-T REMS Program Knowledge Assessment before billing. Contact Gainwell Technologies at 800-457-4584, option 7 for Q2042 prior authorization questions.