MedicaidCoverageMedium impact
BT2025106: Coverage added for physician-administered drug Erzofri (J2428) under the IHCP medical benefit
Indiana Medicaid (IHCP)·IN · Psychiatry, Family Medicine, Internal Medicine·Pharmacy
Effective date
Apr 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid is now covering physician-administered Erzofri (paliperidone palmitate) injections under the medical benefit using HCPCS code J2428, effective retroactively from April 1, 2025. Prior authorization will be required starting August 15, 2025, and all claims must include NDC codes.
Action Required
Immediately: Billing team must update system to bill HCPCS code J2428 for Erzofri injections with required NDC codes. For institutional outpatient claims, bill with revenue code 636. By August 15, 2025: Implement prior authorization requirement for all J2428 claims. Review remittance advices starting August 20, 2025 for reprocessed claims with ICNs beginning with 52 or 80.