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BT202109: Coverage and billing information for the 2021 annual HCPCS codes update
Effective date
Jan 1, 2021
Identified
Jun 19, 2026
Summary
Indiana Medicaid added the 2021 annual HCPCS, CPT and CDT codes with coverage and billing information that applies to dates of service on or after January 1, 2021, unless otherwise specified. Many of the new codes are noncovered, while others are covered, some require prior authorization, and some are manually priced, carved out of managed care, or linked to revenue code 636. COVID-19 testing and treatment codes have their own effective dates in November 2020, and COVID-19 vaccine codes 91302, 0021A and 0022A are listed as awaiting effective dates.
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What to do
Action · 18 steps
01Already effective January 1, 2021 for dates of service on or after that date, unless otherwise specified: Bill each new code 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 in Table 1 are not covered by the IHCP for any programs.
03Prior authorization applies to the codes in Table 7: 81168, 81278 and 81279 (see the Genetic Testing provider reference module, with a limit of 1 per lifetime), C1825 (see the Durable and Home Medical Equipment and Supplies and Surgical Services provider reference modules), C9073 (member must be at least 18 years of age with relapsed or refractory mantle cell lymphoma), D7961 and D7962 (see the Dental Services provider reference module, with a limit of 2 units per date of service), and S0013 (member must be at least 18 years of age and taking an oral antidepressant).
04Bill codes in Table 5 at the percentage of billed charges shown for professional or dental claims and for outpatient claims.
05Bill codes in Table 6 with revenue code 636 for separate reimbursement in an outpatient setting.
06Bill C9073 and J7212 as carved out of managed care and reimbursable outside the inpatient DRG, and J7212 is priced at State Maximum Allowable Costs (SMAC).
07Copay-exempt codes 87428 and U0005 apply to HIP and PE Adult members with no diagnosis match required.
08Code 87428 is billed at $63.59 for professional and outpatient claims, effective 11/10/2020.
09Code M0239 is $309.60 for professional and outpatient claims from 11/10/2020 through 12/31/2020, and $278.98 for professional and $310.75 for outpatient claims from 1/1/2021.
10Code M0243 is $309.60 for professional and outpatient claims from 11/21/2020 through 12/31/2020, and $278.98 for professional and $310.75 for outpatient claims from 1/1/2021.
11Code U0005 is $25.00 effective 1/1/2021.
12Codes Q0239 and Q0243 are available at no charge to providers, and the IHCP will pay zero until further notice.
13Codes 91302, 0021A and 0022A are awaiting effective dates, and additional guidance will be published at a later date.
14Send 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.
15Procedure codes carved out of managed care follow fee-for-service guidance.
16Update the code tables on the Code Sets page for dental, family planning, hearing, physician-administered drugs carved out of managed care, preventive care, procedure codes requiring NDCs, revenue codes with special procedure code linkages, and vision services.
17Providers may submit, resubmit or adjust fee-for-service claims they feel were impacted by the delay in publication.
18For claims with dates of service before the effective date, providers had 90 days from the publication date for managed care claim submission and 180 days for fee-for-service claim submission to bypass timely filing limits, and should include a copy of the bulletin (first page only) when submitting claims beyond the standard filing limit.
Codes mentioned
3046832408337413374533746339953399755880574656970569706712717614580143801518016180167801798018180189801938020480210811688119181192811938119481278812798133881339813478134881351813528135381357813608141981513815148152981546815548207782681874289037792229925179251892519926509265192652926539324193242932439324493245932469324793248946199941799439A9591C1052C1062C1825C9068C9069C9070C9071C9072C9073C9770C9771C9772C9773C9774C9775D0604D0605D0701D0702D0703D0704D0705D0706D0707D0708D0709D1321D1355D2928D3471D3472D3473D3501D3502D3503D5995D5996D6191D6192D7961D7962D7993D7994G0088G0089G0090G2173G2174G2175G2176G2177G2178G2179G2180G2181G2182G2183G2184G2185G2186G2187G2188G2189G2190G2191G2192G2193G2194G2195G2196G2197G2198G2199G2200G2201G2202G2203G2204G2205G2206G2207G2208G2209G2210G2211G2212G2213G2214G2215G2216G2250G2251G2252J0693J1823J7212J7352J9144J9223J9281J9316J9317M0239M0243M1145M1146M1147M1148M1149Q0239Q0243Q5122S0013U000591302
Original notice
BT202109: Coverage and billing information for the 2021 annual HCPCS codes update
in.gov · Always check the source before changing claims.
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