IHCP to Cover Laboratory Pathology Codes & Providers May Resubmit Outpatient Claims for Procedure Code 88344 That Denied Inappropriately

Effective October 1, 2020, the Indiana Health Coverage Programs (IHCP) will cover the molecular pathology procedure codes in Table 1 for laboratory services, as follows. This coverage applies to all IHCP programs, subject to limitations established with certain benefit packages, for claims with dates of service (DOS) on or after October 1, 2020. Table 1 – Molecular pathology laboratory codes coverage, effective October 1, 2020:

81403, 81404, 81405, 81407, 81479, G0452

The Indiana Health Coverage Programs (IHCP) has identified a claim-processing issue that affects certain outpatient fee-for-service (FFS) claims that processed on or after September 21, 2019. Claims or claim details submitted for procedure code 88344 – Special stained specimen slides to examine tissue may have denied inappropriately for explanation of benefits (EOB) 4801 – Procedure code not covered for benefit plan. The claim-processing system has been corrected. Beginning immediately, providers may resubmit claims for code 88344 that previously denied for EOB 4801 during the indicated time frame, for reimbursement consideration. Claims resubmitted beyond the original timely filing limit must be submitted within 180 days of the publication date and include a copy of this banner page as an attachment.