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BT2021113: Coverage and billing information for the 2022 annual HCPCS codes update
Effective date
Jan 1, 2022
Identified
Jun 19, 2026
Summary
Effective for dates of service on or after Jan. 1, 2022, unless otherwise specified, the IHCP covers the new 2022 annual HCPCS codes that are marked covered. Prior authorization is required for pulmonary rehabilitation codes 94625 and 94626, remote monitoring codes 98975, 98976, 98977, 98980 and 98981, code 0673T, aducanumab code J0172, and CAR-T code Q2055. Codes marked noncovered are not covered for any IHCP program. Codes D0606, D1701, D1702, D1703, D1704, D1707 and Q2055 are newly covered and carved out of managed care.
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What to do
Action · 17 steps
01Already effective January 1, 2022: Check current applicability before acting on these codes.
02Billing team: get prior authorization for 94625, 94626, 98975, 98976, 98977, 98980, 98981, 0673T, J0172 and Q2055 under the criteria listed for each code.
03For pulmonary rehabilitation 94625 and 94626, the criteria require a diagnosis of moderate to very severe COPD or other condition, a physician order with aerobic exercise at each session, an individualized plan of care reviewed and signed by the physician every 30 days, and services only at place of service 11 or 22.
04For remote monitoring codes 98975, 98976, 98977, 98980 and 98981, and for 0673T, refer to nationally recognized care guidelines.
05For J0172, the initial authorization requires age 50 through 85, Alzheimer's disease confirmed by amyloid PET (CPT 78814) or cerebrospinal fluid testing, mild cognitive impairment or mild dementia assessed by a CDR global score of 0.5, an RBANS delayed memory index of 85 or less, or an MMSE score of 24 or greater, a baseline brain MRI within the past year, and prescribing by or in consultation with a neurologist, geriatric psychiatrist or geriatrician.
06J0172 is restricted to geriatric practitioners (provider specialty 320), neurological surgeons (325), neurologists (326) and psychiatrists (339).
07For Q2055, the member must be at least 18 years old with relapsed or refractory multiple myeloma after four or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 monoclonal antibody, must not have previously received the specified CAR-T treatment, and must be treated at a REMS Program-certified facility by providers who completed the REMS Knowledge Assessment.
08For D9947, refer to the Maxillofacial Prosthesis section of the Dental Services provider reference module.
09In charge entry, link C9085, C9086, C9087, J0172 and Q2055 to revenue code 636.
10Bill A2001 through A2010 and Q4199 at their flat, statewide, per-unit rate, with podiatrists (provider specialty 140) as the allowed specialty.
11D0606, D1701, D1702, D1703, D1704 and D1707 are restricted to dentists (provider type 27).
12Carved-out codes follow fee-for-service guidance, so send fee-for-service questions to Gainwell Technologies at 800-457-4584, option 7, and send managed care questions to the managed care entity the member is enrolled with.
13Use the new modifiers FQ, FR, FS and FT, effective Jan.
141, 2022.
15For claims with earlier dates of service, managed care claims have 90 days and fee-for-service claims have 180 days from the Dec.
1630, 2021 publication date to bypass timely filing limits, and claims should include the first page of the bulletin.
17Watch for the IHCP notice on any description changes that affect reimbursement.
Codes mentioned
94625946269897598976989779898098981J0172Q2055D9947A2001A2002A2003A2004A2005A2006A2007A2008A2009A2010Q4199C9085C9086C9087D0606D1701D1702D1703D1704D1707
Original notice
BT2021113: Coverage and billing information for the 2022 annual HCPCS codes update
in.gov · Always check the source before changing claims.
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Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesPulmonologyNeurologyGeriatricsPsychiatryHematologyOncologyPodiatryWound CareDentistryCode 94625Code 94626Code 98975Code 98976Code 98977Code 98980Code 98981Code J0172Code Q2055Code D9947Code A2001Code A2002Code A2003Code A2004Code A2005Code A2006Code A2007Code A2008Code A2009Code A2010Code Q4199Code C9085Code C9086Code C9087Code D0606Code D1701Code D1702Code D1703Code D1704Code D1707