MedicaidCoverageMedium impact
BT202230: IHCP updates reimbursement policy regarding aducanumab (Aduhelm) coverage
Indiana Medicaid (IHCP)·IN · Neurology, Geriatrics, Internal Medicine +1 more·Claims & Billing
Effective date
Apr 7, 2022
We identified it
Jun 19, 2026
Summary
IHCP will no longer reimburse claims for aducanumab (Aduhelm) injections using procedure code J0172 for Medicare eligible members with full Medicaid benefits, effective April 7, 2022. This follows CMS's final national coverage determination policy for monoclonal antibodies directed against amyloid for Alzheimer's disease treatment.
Action Required
Immediately: Billing team must stop submitting claims for procedure code J0172 (Injection, aducanumab-avwa, 2 mg) for Medicare eligible members with full Medicaid benefits in Indiana. Update billing system to flag these claims for denial. Ensure claims are processed through medical benefit only, not pharmacy benefit. Contact Gainwell Technologies at 800-457-4584 for FFS questions or the appropriate MCE for HIP/Hoosier Care Connect/Hoosier Healthwise members.