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BT202106: IHCP to update rates for certain DME and medical supply items effective February 1, 2021
Effective date
Feb 1, 2021
Identified
Jun 19, 2026
Summary
Indiana Medicaid changes the reimbursement methodology for select durable medical equipment (DME) and medical supply HCPCS codes for dates of service on or after February 1, 2021, and the codes are subject to the 21st Century Cures Act. Updated maximum fees are listed for each code by modifier, and the capped rental period is 6 months for power wheelchairs and 10 months for other capped rental DME and medical supplies that are subject to the Act, while the 15-month capped rental period remains for codes that are not subject to the Act. Codes E0639 and E0640 move from manual pricing to maximum-fee pricing, and E0467 is a frequently serviced item for which the IHCP reimburses rental payments only.
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What to do
Action · 9 steps
01Already effective February 1, 2021: Bill the listed HCPCS codes for dates of service on or after February 1, 2021 at the max fee shown for each code and modifier in Table 1.
02Use NU for new DME purchase, RR for DME rental, QB or QF for portable oxygen where prescribed amounts meet the stated conditions, and U1 for nonpreferred blood glucose monitors or diabetic test strips.
03Check the capped rental period for each code: bill codes in Table 2 under the 6-month capped rental period, codes in Table 3 under the 10-month capped rental period, and codes in Table 4 under the 15-month capped rental period.
04Codes E0639 and E0640 (Table 5) are reimbursed at maximum fee instead of manual pricing, and pricing attachments such as cost invoices or manufacturer's suggested retail price documentation are no longer required for these codes on claims with dates of service on or after February 1, 2021.
05Do not bill E0467 for purchase, because the IHCP will deny claims for the purchase of this item.
06For E0467, bill rental payments only, as long as the equipment is deemed medically necessary.
07Update charge entry and the DME code tables on the Code Sets page, including Procedure Codes That Require Attachments, Procedure Codes for DME/HME Capped Rental Items, and Procedure Codes for Equipment and Supplies Classified by the IHCP as Requiring Frequent and Substantial Servicing.
08Fee-for-service reimbursement, prior authorization and billing information apply to FFS claims; send managed care billing and prior authorization questions to the managed care entity the member is enrolled with.
09The updated information will be reflected in the next regular update to the Professional Fee Schedule.
Codes mentioned
A5514A7007A7009A7017E0100E0105E0110E0111E0112E0113E0114E0116E0130E0135E0140E0141E0143E0144E0147E0148E0149E0160E0161E0163E0165E0167E0168E0170E0181E0184E0185E0186E0188E0189E0196E0197E0199E0202E0210E0235E0250E0251E0255E0256E0260E0261E0265E0266E0277E0290E0291E0292E0293E0294E0295E0300E0301E0302E0303E0304E0371E0372E0373E0424E0431E0433E0434E0439E0441E0442E0443E0444E0465E0466E0467E0470E0471E0472E0482E0483E0500E0570E0572E0574E0575E0585E0600E0601E0607E0627E0629E0630E0635E0636E0639E0640E0650E0651E0652E0691E0692E0693E0694E0720E0730E0740E0745E0747E0748E0760E0779E0780E0781E0784E0791E0849E0855E0860E0870E0900E0910E0911E0912E0920E0935E0940E0941E0946E1031E1035E1036E1037E1038E1039E1088E1093E1150E1160E1161E1232E1233E1234E1235E1236E1237E1238E1390E1391E1392E1800E1801E1802E1805E1806E1810E1811E1812E1815E1816E1818E1820E1821E1825E1830E1831E1840E1841E2000E2100E2101E2402E2500E2502E2506E2508E2510K0730K0738K0800K0801K0802K0814K0815K0816K0820K0821K0822K0823K0824K0825K0826K0827K0828K0829K0835K0836K0837K0838K0839K0840K0841K0842K0843K0848K0849K0850K0851K0855K0856K0857K0858K0859K0860K0861K0862K0863K0864B9002B9004B9006E0117E0171E0182E0187E0198E0236E0296E0297E0305E0316E0462E0550E0565E0606E0617E0618E0619E0620E0656E0657E0744E0856E0930E0955E0968E0983E0984E0985E0988E1002E1003E1004E1005E1006E1007E1008E1010E1012E1014E1020E1028E1030E1050E1060E1070E1083E1084E1087E1092E1100E1110E1170E1171E1172E1180E1190E1195E1200E1221E1222E1223E1224E1240E1270E1280E1295E2227E2228E2310E2311E2321E2376E2378K0606K0607K0813K0852K0853K0854
Original notice
BT202106: IHCP to update rates for certain DME and medical supply items effective February 1, 2021
in.gov · Always check the source before changing claims.
Related changes
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