What insurance policy changes affect HCPCS T1015?

There are 20 tracked policy changes affecting HCPCS T1015, including updates from Indiana Medicaid (IHCP), MassHealth, Maryland Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS T1015?

Payers that have issued tracked updates for HCPCS T1015 include: Indiana Medicaid (IHCP), MassHealth, Maryland Medicaid, Wisconsin ForwardHealth, Arizona Medicaid - AHCCCS, Texas Medicaid.

How do I get notified when HCPCS T1015 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS T1015. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS T1015?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

T1015 Insurance Policy Changes

HCPCS T1015 is referenced in 20 tracked payer policy changes from Indiana Medicaid (IHCP), MassHealth, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS T1015 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact
BT2020122: IHCP announces procedure codes for newly enrolled behavioral health professionals
Indiana Medicaid (IHCP)·Effective Jan 1, 2021
Indiana Health Coverage Programs (IHCP) now allows six new types of behavioral health professionals to enroll and bill for specific mental health services effective November 1, 2020. Additionally, starting January 1, 2021, mid-level modifiers will no longer override NCCI edits for psychotherapy services billed same-day as evaluation and management services unless the behavioral health provider is individually enrolled.
High impact
BT202112: FSSA announces the addition of COVID-19 vaccine administration billing for FQHC and RHC providers
Indiana Medicaid (IHCP)·Effective Apr 1, 2021
Indiana FSSA will separately reimburse FQHCs and RHCs for COVID-19 vaccine administration starting April 1, 2021. Providers must switch from Zotec billing platform to direct IHCP billing for Medicaid members, using specific POS code 71 and vaccine administration codes without the T1015 encounter code.
High impact
BT202144: FQHC/RHC wraparound supplemental professional claim processing to change July 1
Indiana Medicaid (IHCP)·Effective Jul 1, 2021
Starting July 1, 2021, FQHC and RHC wraparound supplemental payments for medical services will be processed automatically by Gainwell Technologies on a claim-by-claim basis instead of through monthly settlements with Myers and Stauffer. This change affects multiple Medicaid managed care entities and introduces new place of service codes and EOB codes.
High impact
BT202187: FQHC/RHC wraparound supplemental dental claim processing change
Indiana Medicaid (IHCP)·Effective Sep 29, 2021
Starting September 29, 2021, FQHC and RHC dental wraparound payments will be processed automatically by Gainwell Technologies on a claim-by-claim basis instead of through monthly settlements with Myers and Stauffer. Providers must bill code D9999 (limited to one unit per day) for dental encounters and can now use additional place of service codes including telehealth (02), school (03), and homeless shelter (04).
High impact
BT202239: IHCP announces final 2022 telehealth and virtual services code set
Indiana Medicaid (IHCP)·Effective Jul 21, 2022
Indiana Medicaid (IHCP) has finalized its 2022 telehealth code set effective July 21, 2022, adding new audio-only modifier 93, expanding coverage for IOT services and additional E&M codes, and requiring specific POS codes (02 or 10) and modifiers (93 or 95) for telehealth billing. All telehealth services must use codes from the approved tables and will be reimbursed at the same rates as in-person services through the end of 2022.
High impact
BT202253: IHCP allows new POS code for FQHCs and RHCs July 21
Indiana Medicaid (IHCP)·Effective Jul 21, 2022
Indiana Medicaid now allows POS code 10 (telehealth in patient's home) for FQHCs and RHCs starting July 21, 2022. Claims with POS 10 before July 21 will deny and must be corrected using POS 02 and resubmitted.
High impact
BT202309: FSSA announces changes to LARC device billing for FQHC and RHC providers
Indiana Medicaid (IHCP)·Effective Nov 1, 2022
Indiana Medicaid will separately reimburse FQHCs and RHCs for LARC (long-acting reversible contraceptive) devices, carving them out of the PPS rate. Providers must bill LARC devices on separate claims using specific HCPCS codes and cannot include them with T1015 encounter codes.
Medium impact
BT202323: FSSA announces CMS approval for LARC device carve-out for FQHC and RHC providers
Indiana Medicaid (IHCP)·Effective Nov 1, 2022
CMS approved Indiana Medicaid's LARC device carve-out for FQHCs and RHCs, allowing separate reimbursement for contraceptive devices outside the PPS rate. Providers must bill specific HCPCS codes with POS 71 separately from T1015 encounters, effective retroactively from November 1, 2022.
Medium impact
BT202404: IHCP makes correction to FQHC/RHC COVID-19 vaccine guidance
Indiana Medicaid (IHCP)·Effective Jan 18, 2024
Indiana Medicaid corrected guidance for FQHCs and RHCs: they should NOT bill COVID-19 vaccine administration separately from the vaccine itself. Both codes are carved out of managed care and should be submitted together to Gainwell Technologies with POS code 71, without T1015 encounter code.
Medium impact
BT202412: IHCP changes FQHC/RHC billing guidance for crossover claims
Indiana Medicaid (IHCP)·Effective Feb 6, 2024
Indiana Health Coverage Programs (IHCP) has eliminated the requirement for FQHCs and RHCs to include T1015 encounter codes on Medicare crossover claims with dates of service on or after July 1, 2021. This change is effective immediately and also affects HIP Medicare coinsurance claims through May 2024.
Medium impact
BT202511: IHCP updates Notification of Pregnancy billing guidelines for FQHCs and RHCs
Indiana Medicaid (IHCP)·Effective Jan 30, 2025
IHCP updated billing guidelines for Notification of Pregnancy (NOP) claims for FQHCs and RHCs. Effective immediately, these providers must submit NOP claims on the same encounter as other services, not separately as previously required.
High impact
All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations
MassHealth·Effective Sep 23, 2025
MassHealth updated billing requirements for annual behavioral health wellness examinations effective September 23, 2025. The policy provides specific CPT codes and modifiers for different provider types and settings, with no member cost-sharing required.
Medium impact
Managed Care Entity Bulletin 140: Updates to T1015-TH Modifier Use
MassHealth·Effective Nov 1, 2025
Effective November 1, 2025, all community health center visits billed with CPT code T1015 for services by certified nurse midwives or obstetrician gynecologists must include the TH modifier, regardless of whether the service is prenatal/postpartum related. This updates previous guidance and applies to all MassHealth managed care entities.
High impact
PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines
Maryland Medicaid·Effective Mar 3, 2026
Maryland Medicaid has updated coding guidelines for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), clarifying billing procedures for multiple encounters per day and specifying different trigger codes for MCO versus Fee-for-Service claims. The policy details specific submission requirements for somatic, mental health, substance abuse, and dental services.
Medium impact
ForwardHealth Update 2026-03: Revised Billing for Tribal Federally Qualified Health Centers
Wisconsin ForwardHealth·Effective Jan 1, 2024
ForwardHealth (Wisconsin Medicaid) has changed reimbursement for Tribal Federally Qualified Health Centers from a cost-settlement process to either Prospective Payment System (PPS) or All-Inclusive Rate (AIR) options. Tribal FQHCs must now use HCPCS code T1015 for billing encounters and can choose their reimbursement method annually.
Medium impact
BT202593: IHCP updates FQHC and RHC encounter codes
Indiana Medicaid (IHCP)·Effective Jul 28, 2025
Indiana Medicaid (IHCP) is adding 10 new procedure codes as valid encounter codes for FQHC and RHC claims, including retinal imaging, genetic counseling, and telehealth visits. The policy also removes 12 nationally deleted codes from the valid encounter list, with both changes applying retroactively to January 1, 2025.
Medium impact
AHCCCS DFSM Claims Clues - June 2015
Arizona Medicaid - AHCCCS·Effective Jul 1, 2015
AHCCCS is transitioning to a new financial system effective July 1, 2015, changing Fee for Service provider payment schedules and consolidating all payments into single weekly disbursements on Thursdays. The policy also provides updated guidance on FQHC/RHC billing procedures when Medicare or other coverage is the primary payer.
Medium impact
AHCCCS DFSM Claims Clues - July 2015
Arizona Medicaid - AHCCCS·Effective Aug 1, 2015
AHCCCS updated billing requirements for spine surgery CPT codes to allow office setting (POS 11), corrected FQHC/RHC billing procedures for primary payers, and mandated use of revised NEMT trip reports by August 1, 2015.
Medium impact
AHCCCS DFSM Claims Clues - September 2019
Arizona Medicaid - AHCCCS·Effective Sep 1, 2019
AHCCCS updated billing guidelines for assistant surgeon modifiers effective September 1, 2019. Non-physician providers (PA, NP, CNS) must now use only modifier AS when serving as assistant at surgery, while physicians continue using modifiers 80, 81, or 82. Updated MSIC billing requirements specify using MSIC NPI as rendering provider and proper claim form submission.
Low impact
Reimbursement Rate Updates for Procedure Code T1015 Effective January 1, 2026
Texas Medicaid·Effective Jan 1, 2026
Texas Medicaid is implementing reimbursement rate changes for procedure code T1015 (Indian Health Services) effective January 1, 2026. TMHP will automatically identify and reprocess affected claims, with adjustments appearing on future R&S reports.

All billing codes J3590 C9399 J3490 99214 99205 T1016

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BT2020122: IHCP announces procedure codes for newly enrolled behavioral health professionals

BT202112: FSSA announces the addition of COVID-19 vaccine administration billing for FQHC and RHC providers

BT202144: FQHC/RHC wraparound supplemental professional claim processing to change July 1

BT202187: FQHC/RHC wraparound supplemental dental claim processing change

BT202239: IHCP announces final 2022 telehealth and virtual services code set

BT202253: IHCP allows new POS code for FQHCs and RHCs July 21

BT202309: FSSA announces changes to LARC device billing for FQHC and RHC providers

BT202323: FSSA announces CMS approval for LARC device carve-out for FQHC and RHC providers

BT202404: IHCP makes correction to FQHC/RHC COVID-19 vaccine guidance

BT202412: IHCP changes FQHC/RHC billing guidance for crossover claims

BT202511: IHCP updates Notification of Pregnancy billing guidelines for FQHCs and RHCs

All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations

Managed Care Entity Bulletin 140: Updates to T1015-TH Modifier Use

PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines

ForwardHealth Update 2026-03: Revised Billing for Tribal Federally Qualified Health Centers

BT202593: IHCP updates FQHC and RHC encounter codes

AHCCCS DFSM Claims Clues - June 2015

AHCCCS DFSM Claims Clues - July 2015

AHCCCS DFSM Claims Clues - September 2019

Reimbursement Rate Updates for Procedure Code T1015 Effective January 1, 2026