MedicaidPrior AuthMedium impact
BT202238: IHCP establishes billing and prior authorization requirements for RPM services
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Cardiology +3 more·Prior Authorization
Effective date
Jul 21, 2022
We identified it
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.
Action Required
By July 21, 2022: Billing 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. Update billing software to require modifier 95 and place of service codes 02 or 10 for all RPM services. Providers must obtain prescriber's written order and plan of care before submitting PA requests. Contact Gainwell Technologies at 800-457-4584 for PA submissions.