Effective May 1, 2015, the Indiana Health Coverage Programs (IHCP) will add transcatheter aortic valve replacement/transcatheter aortic valve implantation (TAVR/TAVI) as a covered service. Coverage applies to dates of service (DOS) on or after May 1, 2015. The Current Procedural Terminology (CPT®1) codes in Table 1 will be covered for all IHCP programs, subject to limitations established for certain benefit packages. The following reimbursement information applies.
Prior Authorization (PA): None required.
Billing Guidance: Standard billing guidelines apply. See Chapter 8 of the IHCP Provider Manual for billing procedures.
These changes will be reflected in the next monthly updates to the provider Fee Schedule at indianamedicaid.com.
Reimbursement, PA, and billing information apply 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 risk-based managed care (RBMC) delivery system. Questions about RBMC reimbursement information should be directed to the MCE with which the member is enrolled.
