MedicaidPrior AuthHigh impact
BT2020111: IHCP updates policy regarding treatment of spinal stenosis
Indiana Medicaid (IHCP)·IN · Orthopedics, Neurosurgery·Medical Policy
Effective date
Nov 7, 2020
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) is requiring prior authorization for four spinal stenosis procedures (CPT codes 22867-22870) effective November 7, 2020. The policy establishes specific medical necessity criteria including patient age 50+, 6 months of conservative treatment, and specific symptoms, while listing contraindications that make procedures not medically necessary.
Action Required
By November 7, 2020: Billing team must update system to require prior authorization for CPT codes 22867, 22868, 22869, and 22870 for Indiana Medicaid patients. Providers must document medical necessity criteria including patient age 50+, 6 months of nonoperative treatment, specific symptoms, and absence of contraindications. Update encounter forms and EMR templates with required documentation checklist. Claims without prior authorization will be denied.