Who is affected by this change?

This affects Indiana Medicaid (IHCP) Orthopedics, Podiatry, Neurology, Oncology, Hematology, Genetics +7 more providers in IN on Medicaid plans.

When does this change take effect?

This change is effective Apr 1, 2021.

What do I need to do?

Already effective April 1, 2021 for dates of service on or after that date, unless otherwise specified: Bill new codes using the coverage, prior authorization, NDC and special billing information in Table 1, and apply the standard global billing procedures and edits unless special billing guidance is noted. Codes marked Noncovered are not covered by the IHCP for any programs. For K1013, K1014 and K1015, prior authorization is required and these DME codes are allowed for DME provider specialty 250, and K1015 is also allowed for podiatrist specialty 140. For K1013, see the Durable and Home Medical Equipment and Supplies provider reference module for prior authorization criteria. Manually priced K1013, K1014 and K1015 are reimbursed at 75% of manufacturer's suggested retail price (MSRP) or 120% of cost invoice on a professional claim, and the outpatient amount is to be determined. Bill J1427 and Q2053 as carved out of managed care and reimbursable outside the inpatient DRG, and procedure codes carved out of managed care follow fee-for-service guidance. Bill J1427, J1554, J7402, J9037, J9349 and Q2053 with revenue code 636 where appropriate for separate reimbursement in an outpatient setting. For Q2053, the member must be at least 18 years of age with a diagnosis of relapsed or refractory mantle cell lymphoma (MCL). Replace discontinued codes with their alternates: C9068 with A9592, C9069 with J9037, C9070 with J9349, C9071 with J1427, C9072 with J1554, C9073 with Q2053, C9122 with J7402, and J7401 with J7402. Send fee-for-service prior authorization questions to Gainwell Technologies at 1-800-457-4584, option 7, and send managed care prior authorization questions to the managed care entity the member is enrolled with. Update the code tables on the Code Sets page for podiatry services, physician-administered drugs carved out of managed care, procedure codes that require NDCs, revenue codes with special procedure code linkages, and durable and home medical equipment and supplies. Providers may submit, resubmit or adjust fee-for-service claims they feel were impacted by the delay in publication.

← Back to list

Indiana Medicaid (IHCP)Medicaid · Billing Codes · Claims & Billing · IN · Orthopedics, Podiatry, Neurology +10 moreMedium impact

BT202128: Coverage and billing information for the April 2021 HCPCS codes update

Q: Which billing codes are affected?

The following codes are affected: A9592, C9074, C9776, C9777, G2020, G2172, J1427, J1554, J7402, J9037, J9349, K1013, K1014, K1015, K1016, K1017, K1018, K1019, K1020, Q2053, S1091, C9068, C9069, C9070, C9071, C9072, C9073, C9122, J7401.

Effective date

Apr 1, 2021

Identified

Jun 19, 2026

Summary

Indiana Medicaid added the April 2021 HCPCS codes, with coverage and billing information that applies to dates of service on or after April 1, 2021, unless otherwise specified. Most of the new codes are noncovered, while covered codes include DME codes K1013, K1014 and K1015 and the cell therapy code Q2053, which require prior authorization for the listed criteria. Several covered drug and implant codes are linked to revenue code 636 for separate outpatient reimbursement, and discontinued codes C9068, C9069, C9070, C9071, C9072, C9073, C9122 and J7401 have listed alternate codes.

Get alerts when payers change rules like this one

We check Indiana Medicaid (IHCP) and other payers every day and email you when a change matches your specialty and state.

Get Indiana Medicaid (IHCP) alertsPolicy Monitoring is free. No card required.

What to do

Action · 12 steps

01Already effective April 1, 2021 for dates of service on or after that date, unless otherwise specified: Bill new codes using the coverage, prior authorization, NDC and special billing information in Table 1, and apply the standard global billing procedures and edits unless special billing guidance is noted.

02Codes marked Noncovered are not covered by the IHCP for any programs.

03For K1013, K1014 and K1015, prior authorization is required and these DME codes are allowed for DME provider specialty 250, and K1015 is also allowed for podiatrist specialty 140.

04For K1013, see the Durable and Home Medical Equipment and Supplies provider reference module for prior authorization criteria.

05Manually priced K1013, K1014 and K1015 are reimbursed at 75% of manufacturer's suggested retail price (MSRP) or 120% of cost invoice on a professional claim, and the outpatient amount is to be determined.

06Bill J1427 and Q2053 as carved out of managed care and reimbursable outside the inpatient DRG, and procedure codes carved out of managed care follow fee-for-service guidance.

07Bill J1427, J1554, J7402, J9037, J9349 and Q2053 with revenue code 636 where appropriate for separate reimbursement in an outpatient setting.

08For Q2053, the member must be at least 18 years of age with a diagnosis of relapsed or refractory mantle cell lymphoma (MCL).

09Replace discontinued codes with their alternates: C9068 with A9592, C9069 with J9037, C9070 with J9349, C9071 with J1427, C9072 with J1554, C9073 with Q2053, C9122 with J7402, and J7401 with J7402.

10Send fee-for-service prior authorization questions to Gainwell Technologies at 1-800-457-4584, option 7, and send managed care prior authorization questions to the managed care entity the member is enrolled with.

11Update the code tables on the Code Sets page for podiatry services, physician-administered drugs carved out of managed care, procedure codes that require NDCs, revenue codes with special procedure code linkages, and durable and home medical equipment and supplies.

12Providers may submit, resubmit or adjust fee-for-service claims they feel were impacted by the delay in publication.

Codes mentioned

A9592C9074C9776C9777G2020G2172J1427J1554J7402J9037J9349K1013K1014K1015K1016K1017K1018K1019K1020Q2053S1091C9068C9069C9070C9071C9072C9073C9122J7401

Original notice

BT202128: Coverage and billing information for the April 2021 HCPCS codes update

in.gov · Always check the source before changing claims.

View original ↗

BT202109: Coverage and billing information for the 2021 annual HCPCS codes updateMediumEffective Jan 1, 2021 · Claims & Billing BT202158: IHCP updates Outpatient Fee ScheduleMediumNo effective date · Claims & Billing BT202425: Revised coverage and billing information for the 2024 annual HCPCS codes updateHighEffective Jan 1, 2024 · Claims & Billing BT202110: IHCP clarifies drugs carved-out of managed care and PA criteriaMediumEffective Jan 1, 2021 · Managed Care Browse every Indiana Medicaid (IHCP) change in the policy list

BT202128: Coverage and billing information for the April 2021 HCPCS codes update

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

Original notice

Related changes

Related policy hubs

One workspace for payer rules, prior auth, coding and compliance