MedicaidPrior AuthHigh impact
BT202019: IHCP revises policy regarding certain transplant procedures
Indiana Medicaid (IHCP)·IN · Cardiothoracic Surgery, General Surgery, Nephrology +3 more·Medical Policy
Effective date
Apr 10, 2020
We identified it
Jun 19, 2026
Summary
Effective April 10, 2020, Indiana Health Coverage Programs (IHCP/Medicaid) revised transplant procedure policies to use UNOS guidelines as qualifying criteria. All transplant procedures (heart, lung, liver, kidney, pancreas) now require prior authorization with specific medical documentation requirements that must be maintained in patient records.
Action Required
By April 10, 2020: Billing team must ensure all transplant procedures require prior authorization before services are rendered. Update documentation requirements in EMR templates to include specific tests and evaluations for each transplant type (CBC, UA, CMP, chest x-rays, drug screens, cancer screenings, cardiac evaluations, serologies, dental evaluations). Train providers on UNOS guideline requirements for medical necessity documentation. Claims will be denied without proper prior authorization and documentation.