Indiana Code
Chapter 8. Group Insurance for Public Employees
5-10-8-11. Use of Diagnostic or Procedure Codes

Sec. 11. (a) As used in this section, "administrator" means:
(1) the state personnel department;
(2) an entity with which the state contracts to administer health coverage under section 7(b) of this chapter; or
(3) a prepaid health care delivery plan with which the state contracts under section 7(c) of this chapter.
(b) As used in this section, "health care plan" has the meaning set forth in section 7.7 of this chapter.
(c) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.
(d) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
(1) an administrator 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 administrator pays claims for services provided under a health care plan; 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 a health care plan.
(e) If a provider provides services that are covered under a health care plan:
(1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (d); and
(2) before the administrator begins using the most current version of the diagnostic or procedure code;
the administrator 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.1. Amended by P.L.66-2002, SEC.1.

Structure Indiana Code

Indiana Code

Title 5. State and Local Administration

Article 10. Public Employee Benefits

Chapter 8. Group Insurance for Public Employees

5-10-8-0.1. Application of Certain Amendments to Chapter

5-10-8-0.3. Use of Certain Accrued Benefits by State Employees

5-10-8-0.4. Legalization of Certain Payments of Deductible Portion of Group Health Insurance

5-10-8-0.5. Repealed

5-10-8-1. Definitions

5-10-8-2. Repealed

5-10-8-2.1. Repealed

5-10-8-2.2. Public Safety Employees; Surviving Spouses; Dependents

5-10-8-2.5. Repealed

5-10-8-2.6. Local Unit Public Employers and Employees; Programs; Self-Insurance; Payment of Part of Cost; Noncancelability; Retired Employees

5-10-8-2.7. Insurance of Rostered Volunteers

5-10-8-3. Repealed

5-10-8-3.1. Employees Withholding From Salaries or Wages; Retired Employees; Assignment of Part of Retirement Benefit

5-10-8-4. Discrimination as to Form of Insurance Between Certain Employees; Exception

5-10-8-5. Establishment of Common and Unified Plan of Group Insurance

5-10-8-6. Establishment of Common and Unified Plans by State Law Enforcement Agencies; Trust Fund for Prefunding State Contributions and Opeb Liability; Submission of Plan Documents to Budget Agency and Inprs

5-10-8-6.5. General Assembly Members and Former Members

5-10-8-6.6. Repealed

5-10-8-6.7. Election of State Employee Health Care Program by School Corporation

5-10-8-7. Group Insurance; Self-Insurance; Health Services; Disability Plans; Trust Fund for Prefunding State Contributions and Opeb Liability; Investments

5-10-8-7.1. Coverage for Autism Spectrum Disorder

5-10-8-7.2. Breast Cancer; Definitions; Self-Insurance Programs; Health Maintenance Organizations; Diagnostic Services

5-10-8-7.3. Early Intervention Services for First Steps Children

5-10-8-7.5. Prostate Specific Antigen Test

5-10-8-7.7. Surgical Treatment for Morbid Obesity

5-10-8-7.8. Colorectal Cancer Testing Coverage; Exception for High Deductible Health Plans

5-10-8-8. Retired Employees; Ability of Employer to Pay Premiums; Eligibility

5-10-8-8.1. Retired Legislators

5-10-8-8.2. Former Legislators

5-10-8-8.3. Former State and Legislative Employees; Health Benefit Plans

5-10-8-8.4. Revocation or Alteration by Employer

5-10-8-8.5. Establishment of Retiree Health Benefit Trust Fund

5-10-8-9. Coverage of Services for Mental Illness

5-10-8-10. Examining Infants for Hiv; Payment

5-10-8-10.5. Dental Care Provisions Required

5-10-8-11. Use of Diagnostic or Procedure Codes

5-10-8-12. Department Report of the Number of Stimulant Medication Prescriptions for Covered Children Diagnosed With Certain Disorders

5-10-8-13. Mail Order or Internet Based Pharmacy

5-10-8-14. Coverage for Prosthetic Devices

5-10-8-14.8. Employee Health Plan Providing Coverage for Prescription Eye Drops

5-10-8-14.9. Coverage of Methadone

5-10-8-15. Coverage for Care Related to Cancer Clinical Trials

5-10-8-16. High Breast Density

5-10-8-16.5. Post-Mastectomy Coverage

5-10-8-17. Step Therapy Protocol

5-10-8-18. Prescription Drug Coverage

5-10-8-19. Prior Authorization

5-10-8-20. Right to Provide Prescription Cost Information; Point of Sale Cost Limit; Pharmacist May Not Be Required to Collect Higher Copayment

5-10-8-21. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services

5-10-8-22. Coverage for Chronic Pain Management

5-10-8-22.5. Amount Paid for Prescription Drug to Be Counted Against Deductible

5-10-8-23. Reimbursement for Emergency Medical Services

5-10-8-24. Coverage for Pediatric Neuropsychiatric Disorders

5-10-8-25. Disability Plans; Correctional Officer