MedicaidPrior AuthMedium impact
BT2024138: IHCP adds coverage for Adstiladrin (J9029)
Indiana Medicaid (IHCP)·IN · Urology, Oncology·Medical Policy
Effective date
Sep 5, 2023
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) now covers Adstiladrin (nadofaragene firadenovec-vncg) using code J9029 for eligible members 18+ with high-risk BCG-unresponsive non-muscle invasive bladder cancer. Prior authorization is required for dates of service on or after October 1, 2024.
Action Required
By October 1, 2024: Billing team must update system to require prior authorization for HCPCS code J9029 (Adstiladrin) for Indiana Medicaid patients. Ensure all J9029 claims include NDC codes and use revenue code 636 for institutional outpatient claims. Submit PA requests to Acentra Health for FFS medical claims or to member's MCE for managed care. Claims without prior auth after October 1, 2024 will be denied.