Indiana Code 27-8-22.1-5. Use of diagnostic or procedure codes
(1) an insurer shall begin using the version specified in IC 27-1-1.5 of the:
Terms Used In Indiana Code 27-8-22.1-5
- accident and sickness insurance policy: means an insurance policy that provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b), 2(a), 2(b), 2(e), 2(f), and 2(h). See Indiana Code 27-8-22.1-1
- insurer: means :
Indiana Code 27-8-22.1-2
- provider: has the meaning set forth in IC 27-8-11-1. See Indiana Code 27-8-22.1-3
(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 insurer pays claims for services provided under an accident and sickness insurance policy or a worker’s compensation policy; and
(2) a provider shall begin using the version specified in IC 27-1-1.5 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 an accident and sickness insurance policy or a worker’s compensation policy.
(b) If a provider provides services that are covered under an accident and sickness insurance policy or a worker’s compensation policy:
(1) after the date of the version specified in IC 27-1-1.5 of a diagnostic or procedure code described in subsection (a); and
(2) before the insurer begins using the version specified in IC 27-1-1.5 of the diagnostic or procedure code;
the insurer shall reimburse the provider under the version of the diagnostic or procedure code that was specified in IC 27-1-1.5 on the date that the services were provided.
As added by P.L.161-2001, SEC.4. Amended by P.L.66-2002, SEC.16; P.L.124-2018, SEC.84.