Sec. 7.2. (a) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.
(b) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
(1) the office shall for all purposes begin using the most current version of the:
(A) current procedural terminology (CPT);
(B) international classification of diseases (ICD);
(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
(D) current dental terminology (CDT);
(E) Healthcare common procedure coding system (HCPCS); and
(F) third party administrator (TPA);
codes under which the office processes claims for services provided under the Medicaid program; and
(2) a provider shall begin using the most current version of the:
(A) current procedural terminology (CPT);
(B) international classification of diseases (ICD);
(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
(D) current dental terminology (CDT);
(E) Healthcare common procedure coding system (HCPCS); and
(F) third party administrator (TPA);
codes under which the provider submits claims for payment for services provided under the Medicaid program.
(c) If a provider provides services that are covered under the Medicaid program:
(1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (b); and
(2) before the office begins using the most current version of the diagnostic or procedure code;
the office shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.
As added by P.L.161-2001, SEC.2. Amended by P.L.66-2002, SEC.4; P.L.27-2011, SEC.3.
Structure Indiana Code
Chapter 13. Provider Payment; General
12-15-13-0.1. Application of Certain Amendments to Chapter
12-15-13-0.6. "Clean Claim" for Purposes of Ic 12-15-14
12-15-13-0.7. Addition, Deletion, or Modification of Locators
12-15-13-1.5. Payment of Interest on Claims Submitted by Nursing Facilities
12-15-13-1.6. Payment, Denial, or Suspension of Claims; Notice of Suspension or Denial
12-15-13-1.7. Timing of Payment or Denial of Claims; Payment of Interest
12-15-13-3.5. Recovery of Overpayment to Noninstitutional Provider; Appeal
12-15-13-4. Recovery of Overpayment to Institutional Provider; Appeal
12-15-13-6. Notices or Bulletins; Timing; Noncompliance