IHCP Updates - Published 1/3

The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at https://www.in.gov/medicaid/providers/ on January 3, 2019, (unless alternate date is noted).

Provider Reference Modules 
Division of Disability and Rehabilitative Services Home and Community-Based Services Waivers (see the module for a complete list of updates)

• Changed ISP references to Person-Centered/Individualized Support Plan (PC/ISP)
  
• Updated 450B form references to Confirmation of Diagnosis (State Form 54727)
  
• Updated the responsibilities in Section 1.2: FSSA Division of Disability and Rehabilitative Services (DDRS)
  
• Updated the responsibilities and oversight activities in Section 1.4: The Bureau of Quality Improvement Services (BQIS)
  
• Updated Section 2.1: Provider Application Process
  
• Updated the list of items the provider is evaluated on in Section 2.2: Provider Reapproval; also clarified that a signed Provider Agreement is the document needed for reapproval
  
• Updated the current process and FSW POC/CCB cap amount where needed
  
• Updated information about funding and allocations in Section 6.4: Translating Algo Level into a Budget Allocation
  
• Updated new policy and waiver information where needed
  
• Updated the responsibilities regarding face-to-face contact in Section 7.6: Service Plan Implementation and Monitoring
  
• Added Section 9.7: Case Record Reviews and Section 9.8: Data Driven Reviews
  
• Updated Table 3 – Medicaid Waiver Services, Codes, and Rates, Effective August 1, 2018
  
• Removed monthly limit for RHS Daily participants in the Limitations section for Community-Based Habilitation – Individual 

Surgical Services (see the module for a complete list of updates)

• Added information in the Multiple Procedures section about surgeons serving as assistant surgeons for each other when a member requires two procedures by two different surgical specialists
• Updated documentation requirements and the modifiers for when an assistant is needed in the Assistant Surgeons section
• Added information to the Split Care section, including that the IHCP recognizes split care only for the intraoperative and postoperative components
• Added the Plastic or Reconstructive Surgery section and subsections
• Added the Maxillofacial Surgery section and subsections
• Added the Cleft Lip and Cleft Palate section
• Added the Sinus Surgery section and subsections
• Added the Urethral Bulking Agents for Stress Urinary Incontinence section
• Updated the Bariatric Surgery and Revisions section and added subsections
• Added the Transplant Procedures section and subsections
• Updated the Implantable DME section and subsections, including adding the Artificial Heart and Cochlear Implants subsections 

Radiology Services

• Removed examples of situations not typically requiring radiology from the Coverage and Limitations for Radiology Services section
• Updated the Billing and Reimbursement for Radiology Services section, including: 
  • Clarified and expanded billing and reimbursement information for professional and technical components 
  • Incorporated information from the former Angiographic Procedures section 
  • Clarified the note regarding hospice members
• Added the Liver Elastography section 
  • Updated the PET Scans section, including:Added a reference to the new Radiology Services Codes 
  • Updated the billing instructions and provided a reference to section with full instructions
• Updated billing instructions in the Proton Treatment section
• Removed the Radionuclide Bone Scans section

Code Table and Other Updates
The following code table updates are now available on the Code Sets page:

Radiology Services Codes

• New document with the following code tables: 
  • Procedure Codes for Positron Emission Tomography (PET) Scans for Myocardial Perfusion 
  • ICD-10 Diagnosis Codes Supporting Medical Necessity for PET scans for Myocardial Perfusion 
  • Procedure Codes for PET Scans for Refractory Seizures 
  • ICD-10 Diagnosis Codes Supporting Medical Necessity for PET Scans for Refractory Seizures 
  • Procedure Codes for PET Scans for Cancer (Breast, Whole Body, or Regional Head and Neck) 
  • ICD-10 Diagnosis Codes Supporting Medical Necessity for PET Scans for Cancer (Breast, Whole Body, or Regional Head and Neck)

Surgical Services Codes

• All codes were reviewed
• Removed service-specific procedure code tables
• Added the following table: 
  • Implantable Durable Medical Equipment (DME) Separately Reimbursable in the Outpatient Setting

Check out these resources to stay up-to-date with the most recent changes at the IHCP.