MedicaidReimbursementMedium impact
BT202540: IHCP updates outpatient rate for procedure code 36416; claims to be mass adjusted
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) has decreased the reimbursement rate for CPT code 36416 (blood draw) from $3.89 to $3.81, effective January 1, 2025. Claims previously paid at the higher rate will be automatically mass-adjusted starting April 23, 2025.
Action Required
By April 23, 2025: Billing team should expect to see mass adjustment transactions on remittance advices with ICNs/Claim IDs beginning with 52. Monitor RAs for automatic adjustments reducing CPT 36416 payments from $3.89 to $3.81 for Indiana Medicaid claims. No action required as IHCP will automatically process adjustments.