MedicaidBilling CodesHigh impact
BT202670: IHCP removes certain procedure codes from the renal dialysis composite rate
Indiana Medicaid (IHCP)·IN · Nephrology·Claims & Billing
Effective date
May 7, 2026
We identified it
Jun 18, 2026
Summary
Indiana Health Coverage Programs (IHCP) removed three ESRD drug codes (J0605, J0609, J0911) from the renal dialysis composite rate, effective immediately with retroactive application. These codes will now be separately reimbursed when billed with proper documentation and NDC information for ESRD patients receiving outpatient dialysis.
Action Required
Immediately: Billing team must update workflows to bill codes J0605, J0609, and J0911 separately from renal dialysis composite rate. Include appropriate units and NDC information on claims. Ensure clinical documentation supports ESRD-related use consistent with TDAPA criteria. Monitor remittance advices beginning June 10, 2026 for reprocessed claims with ICNs starting with 52. Do not bill these codes on same date of service as renal dialysis composite-rate revenue codes as they will not be separately reimbursed.