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Indiana Medicaid (IHCP)Medicaid · Prior Auth · Prior Authorization · IN · Family Medicine, Internal Medicine, Cardiology +3 moreMedium impact

BT202238: IHCP establishes billing and prior authorization requirements for RPM services

Act
by Jul 21, 2022
Effective date
Jul 21, 2022
Identified
Jun 19, 2026

Summary

Indiana Medicaid (IHCP) is implementing new coverage for Remote Patient Monitoring (RPM) services with prior authorization requirements for most RPM codes. Specific patient eligibility criteria, plan of care documentation, and billing requirements with telehealth modifiers are now required.

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What to do

by Jul 21, 2022 · 4 steps
01Billing team must update system to require prior authorization for RPM codes 99091, 99453, 99454, 99457, 99458, 98975, 98976, 98977, 98980, and 98981 for Indiana Medicaid patients.
02Update billing software to require modifier 95 and place of service codes 02 or 10 for all RPM services.
03Providers must obtain prescriber's written order and plan of care before submitting PA requests.
04Contact Gainwell Technologies at 800-457-4584 for PA submissions.

Codes mentioned

9909199453994549945799458932289322993268932709327193272932989897598976989779898098981994739947499600

Original notice

BT202238: IHCP establishes billing and prior authorization requirements for RPM services
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT2021113: Coverage and billing information for the 2022 annual HCPCS codes updateMediumEffective Jan 1, 2022 · Claims & BillingBT202158: IHCP updates Outpatient Fee ScheduleMediumNo effective date · Claims & BillingBT202147: Home health rates for state fiscal years 2022 and 2023 are effective July 1, 2021MediumEffective Jul 1, 2021 · Specialty ServicesBT202276: IHCP announces EVV home health policy detailsHighEffective Nov 5, 2022 · Medical PolicyBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesFamily MedicineInternal MedicineCardiologyEndocrinologyPulmonologyNephrologyCode 99091Code 99453Code 99454Code 99457Code 99458Code 93228Code 93229Code 93268Code 93270Code 93271Code 93272Code 93298Code 98975Code 98976Code 98977Code 98980Code 98981Code 99473Code 99474Code 99600

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