Indiana Code 27-1-37.5-13.5. State employee health plan prohibited from requiring prior authorization for certain CPT codes; retroactive denial; review of impact
(b) The state employee health plan may not require a participating provider to obtain prior authorization for the following CPT codes:
Terms Used In Indiana Code 27-1-37.5-13.5
- CPT code: refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association. See Indiana Code 27-1-37.5-3
- health plan: means any of the following that provides coverage for health care services:
Indiana Code 27-1-37.5-5
- Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. See Indiana Code 27-1-2-3
- participating provider: refers to the following:
Indiana Code 27-1-37.5-6
- prior authorization: means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. See Indiana Code 27-1-37.5-7
(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.
As added by P.L.190-2023, SEC.17.