2025 HCPCS and Physician Administered Drug Reimbursement Updates (IB 25-17)

Date: 06/09/25

Louisiana Healthcare Connections is notifying providers of  the 2025 HCPCS and Physician-Administered Drug Reimbursement Updates (IB 25-17) made on June 9, 2025.

The Louisiana Medicaid fee-for-service (FFS) files have been updated to incorporate the new and revised Healthcare Common Procedure Coding System (HCPCS) codes effective for services rendered on or after January 1, 2025. These updates were reflected in the FFS remittance advice issued on May 20, 2025. Claims initially denied due to the use of the new 2025 HCPCS codes prior to their integration into the claims processing system will be automatically reprocessed. No action is required from providers.

Louisiana Medicaid is updating reimbursement rates within the FFS files for physicianadministered drugs (PAD) under Professional Services, effective January 1, 2025. New rates for PADs that require a wholesale acquisition cost will be phased in over the upcoming weeks.

After completion, claims processed at the prior rates will be automatically adjusted, ensuring accurate reimbursement. Providers are not required to take any further action during this process.

If you have questions about fee-for-service Medicaid claims processing, contact Gainwell Technologies Provider Services at (800) 473-2783 or (225) 924-5040.

Providers with questions regarding managed care claims can contact provider relations at 1-866-595-8133.

Louisiana Healthcare Connections is updating our system to reflect the changes above within 30 days of this notification (Section 2.18.9.5 of the contract). We will recycle any claims that were not paid in accordance with 2025 HCPCS and physician-administered drug updates within 30 calendar days of this notice.