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Indiana Code Title 27. Insurance § 27-1-37.5-13.5

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 13.5. (a) This section applies only to the state employee health plan (as defined in IC 5-10-8-6.7(a)).

(b) The state employee health plan may not require a participating provider to obtain prior authorization for the following CPT codes:

(1) 11200.

(2) 11201.

(3) 17311.

(4) 17312.

(5) 17313.

(6) 17314.

(7) 44140.

(8) 44160.

(9) 44970.

(10) 49505.

(11) 70450.

(12) 70551.

(13) 70552.

(14) 70553.

(15) 71250.

(16) 71260.

(17) 71275.

(18) 72141.

(19) 72148.

(20) 72158.

(21) 73221.

(22) 73721.

(23) 74150.

(24) 74160.

(25) 74176.

(26) 74177.

(27) 74178.

(28) 74179.

(29) 74181.

(30) 74183.

(31) 78452.

(32) 92507.

(33) 92526.

(34) 92609.

(35) 93303.

(36) 93306.

(37) 95044.

(38) 95806.

(39) 95810.

(40) 97110.

(41) 97112.

(42) 97116.

(43) 97129.

(44) 97130.

(45) 97140.

(46) 97530.

(47) V5010.

(48) V5256.

(49) V5261.

(50) V5275.

(c) The state employee health plan may not issue a retroactive denial for medical necessity for a CPT code listed in subsection (b).

(d) Before November 1, 2025, the:

(1) interim study committee on public health, behavioral health, and human services;  and

(2) interim study committee on financial institutions and insurance;

shall jointly review the impact of this section, including any relief on the administrative burdens to participating providers and any differences in utilization of the CPT codes listed in subsection (b).

(e) This section expires June 30, 2026.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-1-37.5-13.5 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-13-5/

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