MedicaidPrior AuthMedium impact
BT202242: IHCP revises home oxygen PA criteria
Indiana Medicaid (IHCP)·IN · Pulmonology, Internal Medicine, Family Medicine +2 more·Provider Bulletin
Effective date
Jul 1, 2022
We identified it
Jun 19, 2026
Summary
Effective July 1, 2022, the Indiana Health Coverage Programs (IHCP) revised prior authorization criteria for home oxygen equipment and supplies. All oxygen equipment, concentrators, and portable liquid oxygen now require prior authorization with specific medical necessity documentation and testing requirements within 30 days of initial certification.
Action Required
By July 1, 2022: Billing team must ensure all home oxygen equipment claims for IHCP members include prior authorization before billing. Providers must complete and submit medical necessity forms (CMS-484 or equivalent) with arterial blood gas or oximetry test results within 30 days of certification. Update billing system to flag all oxygen-related claims for IHCP plans for prior auth verification. Claims without proper prior authorization will be denied.