BT2026182

Indiana Health Coverage Programs (IHCP) Bulletin BT2026182, issued October 29, 2026, announces that COVID-19 vaccines and vaccine administration services will no longer be carved out of managed care under the medical benefit for members enrolled in the Healthy Indiana Plan (HIP), Hoosier Healthwise, Hoosier Care Connect, and Indiana PathWays for Aging (PathWays), effective January 1, 2027. For dates of service on or after January 1, 2027, professional and institutional claims for COVID-19 vaccines and vaccine administration services furnished to managed care members must be submitted to the managed care organization (MCO) with which the member is enrolled, rather than to the fee-for-service (FFS) claim processor. The affected procedure codes are: 90480, 91304, 91318, 91319, 91320, 91321, and 91322. These codes will be removed from the Physician-Administered Drugs Carved Out of Managed Care and Reimbursable Outside the Inpatient DRG code set. FQHCs and RHCs are excepted from this transition. Both the COVID-19 vaccine and its administration remain carved out of the managed care delivery system for FQHCs and RHCs. These providers must continue to submit all claims for these services to the FFS claim processor using place of service code 71 (Public health clinic) and without the T1015 encounter code. The COVID-19 vaccine administration fee also remains carved out of the FQHC/RHC prospective payment system (PPS) rate, and the vaccine itself pays at zero dollars as it is included in the PPS payment logic. IHCP states that this change builds on the prior carve-in of pharmacy claims for COVID-19 vaccines described in IHCP Bulletin BT2024135, and aligns benefit administration with requirements under the American Rescue Plan Act of 2021 (ARP) and the conclusion of COVID-19 public health emergency (PHE) flexibilities.