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MedicaidCoverageMedium impact

BT202128: Coverage and billing information for the April 2021 HCPCS codes update

Indiana Medicaid (IHCP)·IN · Oncology, OB-GYN, PM&R (Physical Medicine & Rehab) +1 more·Claims & Billing
Effective date
Apr 1, 2021
We identified it
Jun 19, 2026
Days to comply

Summary

Indiana Medicaid has updated coverage and billing guidelines for new HCPCS codes effective April 1, 2021. The update includes new covered injection codes requiring NDCs, covered DME codes requiring prior authorization, and multiple noncovered codes that should not be billed to Indiana Medicaid.

Action Required

Action needed
Immediately: Update billing system to reflect new HCPCS code coverage status - mark codes 0242U, 0243U, 0244U, 0245U, 0246U, 0247U, A9592, C9074, C9776, C9777, G2020, G2172, K1016, K1017, K1018, K1019, K1020, S1091 as noncovered for Indiana Medicaid to prevent claim denials. Configure prior authorization requirements for codes K1013, K1014, K1015, Q2053. Set up NDC requirements for injection codes J1427, J1554, J7402, J9037, J9349, Q2053. Verify all changes apply retroactively to April 1, 2021 dates of service.

Affected Billing Codes

A9592
C9074
C9776
C9777
G2020
G2172
J1427
J1554
J7402
J9037
J9349
K1013
K1014
K1015
K1016
K1017
K1018
K1019
K1020
Q2053
S1091