IHCP banner page INDIANA HEALTH COVERAGE PROGRAMS BR201944 OCTOBER 29, 2019 IHCP to cover HCPCS code J1095 (Dexycu) Effective November 29, 2019, the Indiana Health Coverage Programs (IHCP) will cover Healthcare Common Procedure Coding System (HCPCS) code J1095 – Injection, dexamethasone 9 percent, intraocular, 1 microgram. Coverage applies to all IHCP programs, subject to limitations established for certain benefit plans, for claims with dates of service (DOS) on or after November 29, 2019. The following reimbursement information applies: Pricing: Maximum fee Prior authorization (PA): None required Billing guidance: Must be billed with the National Drug Code (NDC) of the product administered Separate reimbursement is allowed under revenue code 636 – Drugs Requiring Detailed Coding. For reimbursement consideration, providers may bill the procedure code and the revenue code together, as appropriate. Reimbursement, PA, and billing information applies to services delivered under the fee-for-service (FFS) delivery system. Individual managed care entities (MCEs) establish and publish reimbursement, PA, and billing criteria within the managed care delivery system. Questions about managed care billing and PA should be directed to the MCE with which the member is enrolled. This information will be reflected in the Procedure Codes That Require NDCs and the Revenue Codes with Special Procedure Code Linkages tables, accessible from the Code Sets web page. Additionally, this change will be indicated in the next regular updates to the Professional Fee Schedule and the Outpatient Fee Schedule, accessible from the IHCP Fee Schedules page at in.gov/medicaid/providers. 1 of 6 IHCP to cover CPT code 22858 IHCP adds CPT code 64615 to Injections, Vaccines, and Other Physician-Administered Drugs Codes IHCP clarifies billing requirements for mental health therapy services in outpatient facilities Outpatient HAF applied to IHCP allowed amount, effective December 1, 2019 IHCP to present live webinar for VFC providers, November 12, 2019 MORE IN THIS ISSUE
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IHCP banner page INDIANA HEALTH COVERAGE PROGRAMS BR201944 OCTOBER 29, 2019
IHCP to cover HCPCS code J1095 (Dexycu) Effective November 29, 2019, the Indiana Health Coverage Programs (IHCP) will cover Healthcare Common Procedure
Table 1 – Outpatient mental health therapy procedure codes linked to 90X or 91X series revenue codes, effective for DOS on or after March 15, 2018
* Code 0359T was end dated December 31, 2018.
Table 2 – Revenue codes covered, effective for DOS on or after March 15, 2018
Procedure code
Description
* 0359T Behavior identification assessment
90785 Interactive complexity
90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90833 Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure)
90834 Psychotherapy, 45 minutes with patient and/or family member
90836 Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure)
90837 Psychotherapy, 60 minutes with patient and/or family member
90838 Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure)
90839 Psychotherapy for crisis, first 60 minutes
90840 Psychotherapy for crisis, each additional 30 minutes
90845 Medical psychoanalysis
90846 Family psychotherapy (without the patient present)
90847 Family psychotherapy (conjoint psychotherapy) (with patient present)
90849 Multi-family group psychotherapy
90853 Group psychotherapy (other than of a multi-family group)
Procedure code
Description Flat rate
900 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-General
$40.80
907 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Community Behavioral Health Program (Day Treatment)
$40.80 (individual) $20.40 (group)
914 Behavioral Health Treatments/Services-Extension of 090X-Individual Therapy $40.80
915 Behavioral Health Treatments/Services-Extension of 090X-Group Therapy $20.40
916 Behavioral Health Treatments/Services-Extension of 090X-Family Therapy $20.40
918 Behavioral Health Treatments/Services-Extension of 090X-Testing $40.80
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IHCP banner page BR201944 OCTOBER 29, 2019
These changes are reflected in the Revenue Codes with Special Procedure Code Linkages, accessible from the Code
Sets web page, and in the Outpatient Fee Schedule, accessible from the IHCP Fee Schedules page at in.gov/medicaid/
providers.
1CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical
Association.
Outpatient HAF applied to IHCP allowed amount, effective December 1, 2019
Effective December 1, 2019, fee-for-service (FFS) claims for outpatient services, submitted with revenue codes
reimbursed at a flat rate by Hospital Assessment Fee (HAF)-participating hospitals, will have the HAF adjustment applied
to the Indiana Health Coverage Programs (IHCP) allowed amount. This change will apply to claims for outpatient
services with dates of service (DOS) on or after December 1, 2019.
Before this change, the IHCP calculated the IHCP allowed amount
based on the units billed. The HAF adjustment will be applied to
revenue code flat fee rates. The IHCP does not apply the lesser of
reimbursement methodology for outpatient HAF.
As a reminder, FFS claims paid using the HAF reimbursement
methodology will continue to receive the detail level explanation of