§ 27-1-37.5-13.5 — State employee health plan prohibited from requiring prior authorization for certain CPT codes; retroactive denial; review of impact

Indiana § 27-1-37.5-13.5

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 1: DEPARTMENT OF INSURANCE
• Ch. 37.5: Health Care Service Prior Authorization

Text

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.

Legislative History

As added by P.L.190-2023, SEC.17.