MedicaidBilling CodesMedium impact
BT202579: IHCP updates code S0145 to be carved out of managed care
Indiana Medicaid (IHCP)·IN · Gastroenterology, Infectious Disease, Oncology·Managed Care
Effective date
Jun 5, 2023
We identified it
Jun 18, 2026
Summary
Indiana Health Coverage Programs (IHCP) has carved out HCPCS code S0145 (pegylated interferon alfa-2a injection) from managed care, requiring all claims to be billed as fee-for-service directly to Gainwell instead of managed care entities. This change is retroactive to June 5, 2023, and managed care payments for this code will be recouped and require re-billing.
Action Required
Within 180 days of June 5, 2025: Billing team must identify all claims for S0145 (pegylated interferon alfa-2a injection) paid by managed care entities since June 5, 2023. Re-submit these claims to Gainwell for fee-for-service reimbursement, including a copy of bulletin BT202579 for claims beyond standard filing limits. Update billing workflows to always bill S0145 directly to Gainwell as FFS, even for managed care members.