MedicaidPrior AuthHigh impact
BT202002: IHCP revises policy for radiology services
Indiana Medicaid (IHCP)·IN · Radiology, Diagnostic Imaging, Nuclear Medicine +2 more·Medical Policy
Effective date
Feb 7, 2020
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) is implementing comprehensive changes to radiology services coverage effective February 7, 2020, including new prior authorization requirements for all PET scans and interventional radiology procedures, expanded coverage for specific sonography procedures, and stricter limitations on the number of radiologic views permitted.
Action Required
Before February 7, 2020: Billing team must update prior authorization processes to require PA for ALL PET scans and interventional radiology procedures for Indiana Medicaid patients. Remove diagnosis codes supporting PET scan medical necessity from billing system as they become obsolete. Update documentation requirements to justify minimum necessary views/films for all radiologic procedures and ensure CT scans include medical necessity documentation. Train staff on expanded sonography coverage including Venous Doppler, soft tissue diagnostic exams, and echocardiograms. Failure to obtain required prior authorizations will result in claim denials.