MedicaidPrior AuthMedium impact
BT2024177: IHCP adds prior authorization requirement for medical and dental frenectomy codes
Indiana Medicaid (IHCP)·IN · Oral & Maxillofacial Surgery, ENT (Ear, Nose & Throat), Pediatrics +1 more·Prior Authorization
Effective date
Dec 12, 2024
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) will require prior authorization for all medical and dental frenectomy procedures effective December 12, 2024. This applies to all ages with specific clinical criteria for infants versus patients over 1 year old.
Action Required
By December 12, 2024: Billing team must update system to require prior authorization for CPT codes 40806, 40819, 41010, 41115 and CDT codes D7961, D7962 for Indiana Medicaid patients. Providers must obtain prior auth before performing frenectomy procedures and maintain required documentation including referrals, photographs, and clinical notes. Claims without prior authorization will be denied.