When does this change take effect?

This change is effective Aug 16, 2022.

MedicaidBilling CodesLow impact

BT202266: IHCP announces billing guidance for Paxlovid pharmacy claims

Q: Who is affected by this change?

This affects Indiana Medicaid (IHCP) Family Medicine, Internal Medicine, General Practice providers in IN on Medicaid plans.

Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice·Pharmacy

Effective date

Aug 16, 2022

We identified it

Jun 19, 2026

Days to comply

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Summary

Indiana Medicaid (IHCP) will now reimburse pharmacies for Paxlovid prescriptions ordered by pharmacists under FDA's Emergency Use Authorization. Pharmacy claims must use specific NCPDP codes including professional service code 'PE' and a $10.48 administration fee.

Action Required

Action needed

Immediately: Pharmacy billing staff must update OptumRx claims submission to use professional service code 'PE' and $10.48 administration fee for pharmacist-ordered Paxlovid claims. Use pharmacy NPI as both provider and prescriber NPI, or individual pharmacist NPI with submission clarification code 42 if needed. Contact OptumRx Clinical and Technical Help Desk at 855-577-6317 for FFS members or respective MCE for managed care members with questions.

Related policy hubs

Indiana Medicaid (IHCP) policies IN policy changes Family Medicine Internal Medicine General Practice