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BT2020127: IHCP to reimburse pharmacy providers for COVID-19 vaccine administration
Act
immediately
Effective date
Dec 15, 2020
Identified
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) now reimburses pharmacy providers for COVID-19 vaccine administration effective immediately. COVID-19 vaccination claims must be submitted to OptumRx fee-for-service PBM instead of managed care PBMs, with specific billing codes and administration fees ranging from $16.94 to $28.39.
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What to do
immediately · 4 steps
01Pharmacy billing teams must redirect all IHCP COVID-19 vaccination claims from managed care PBMs to OptumRx fee-for-service PBM using BIN 001553 and PCN INM.
02Use specific Professional Service Code MA with Service Clarification Code 2 for first dose ($16.94 admin fee) and code 6 for second dose ($28.39 admin fee).
03Submit claims under Dr. Kristina M Box NPI 1730161647 as prescriber until system updates are complete.
04Claims submitted to managed care PBMs will be denied.
Original notice
BT2020127: IHCP to reimburse pharmacy providers for COVID-19 vaccine administration
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202218: IHCP to cover additional COVID-19 vaccine and administration codesMediumEffective Jan 3, 2022 · Provider BulletinBT202224: Pharmacy claim processing clarified for administration of third and booster doses of COVID-19 vaccineMediumEffective Apr 1, 2022 · PharmacyBT202267: IHCP to cover Novavax COVID-19 vaccine and administrationMediumEffective Jul 13, 2022 · Provider BulletinBT202338: IHCP issues reimbursement updates for COVID-19 vaccine administrationMediumEffective Jan 1, 2023 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list