ModifiedIowa Department of Health and Human ServicesPolicy N/A
Iowa Medicaid CY2026 Addendum B — CPT/HCPCS code listing and payment attributes
Customize your policy alerts
Sign up for all Iowa Department of Health and Human Services policy alerts
Know when Iowa Department of Health and Human Services releases new policies or updates existing guidance.
Monitor payer policy activity
Receive email alerts as soon as relevant payer policies are published or updated.
This document is an addendum to Iowa Medicaid's Calendar Year 2026 fee schedule listing CPT/HCPCS (and some lab/dental) codes with short descriptors and payment attributes; it governs billing/payment attributes for Iowa Medicaid claims and affects providers submitting claims to Iowa Medicaid. This is Part 1 of a multi-part document.
Policy Summary
PayerIowa Department of Health and Human Services
PolicyIowa Medicaid CY2026 Addendum B — CPT/HCPCS code listing and payment attributes
Policy CodePolicy N/A
Change TypeCodes added/flagged (0029U, 0031U)
Effective DateJul 1, 2026
Last ReviewJul 1, 2026
Next Review Date
Key ActionWhen billing, use the listed Iowa Medicaid Payment Type, APC Status Indicator, Fee Schedule Amount/Type, Max Units, and PA IND fields for each code.
SourceLink
POLICY UPDATE CHANGES
Code 0029U is marked with an asterisk indicating a change from the previous quarter and an Effective Date of Change = 2026-07-01 00:00:00.
Code 0031U is marked with an asterisk indicating a change from the previous quarter and an Effective Date of Change = 2026-07-01 00:00:00.
≥2codes flagged with '*'
somefees specified
someanesthesia base-unit entries
20+distinct codes listed (partial)
Coverage and Payment Attributes (fee schedule rows)
Code-level payment attributes (examples)
Payment and administrative attributes for listed codes
Each fee-schedule line lists payment and administrative attributes including Iowa Medicaid Payment Type, APC Status Indicator, APC (when assigned), APC Relative Weight (when assigned), Iowa Medicaid Max Units (when present), Iowa Medicaid PA IND (N, R, or blank), Iowa Medicaid Control Code, Iowa Medicaid Anesthesia Base Unit (when applicable), Iowa Medicaid Fee Schedule Amount (when provided), and Iowa Medicaid Fee Schedule Type (e.g., LAB, ANES, FS, NO).
Example code-level attributes: 00100 — Payment Type = APC; APC Status Indicator = N; Iowa Medicaid PA IND = N (anesthesia example).
Example laboratory code: 0016U — Fee Schedule Amount = 155.76; Fee Schedule Type = LAB; Iowa Medicaid Max Units = 1; Iowa Medicaid PA IND = R (requires prior authorization).
Code-level payment/statu s entries (sample)
Coverage stance reflected by payment type and APC status indicators in the fee schedule entries
Some codes are marked as changed from the previous quarter and include an Effective Date of Change field (example: 0029U Change Type Indicator = 5; Effective Date of Change = 2026-07-01).
Example code entry: 0031U — Iowa Medicaid Payment Type = NO; APC Status Indicator = (as listed); marked with change indicators in this addendum where shown.
Example fee-row criterion
Payment and administrative attributes shown for specific codes
Example fee-row: 0040U — Iowa Medicaid Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; Iowa Medicaid PA IND = R; Iowa Medicaid Fee Schedule Amount = 389.41; Fee Schedule Type = LAB.
Administrative/payment attributes
Payment attributes and administrative indicators for listed codes
Iowa Medicaid Payment Type values include APC, FS, NO, APC-FS and determine the payment classification on claims (examples shown across entries).
APC Status Indicator values (examples: N, C, A, J1, Q4, Q1, S) appear per line and affect APC grouping or special status for outpatient services.
Anesthesia lines may include an 'Iowa Medicaid Anesthesia Base Unit' numeric value which is used for anesthesia payment calculation (examples: 180, 120, 195).
The 'Iowa Medicaid PA IND' field indicates prior authorization requirement: typical values seen are N (no), R (requires review/prior authorization), or blank; these are specified per code line.
Fee schedule field rules (informational)
Fee-schedule line item fields and common values observed in this excerpt
Common fee-schedule fields present on each line: code, short descriptor, Iowa Medicaid Payment Type, APC Status Indicator, APC, APC Relative Weight, Iowa Medicaid Max Units, Iowa Medicaid PA IND, Iowa Medicaid Control Code, Iowa Medicaid Anesthesia Base Unit, Iowa Medicaid Fee Schedule Amount, Iowa Medicaid Fee Schedule Type, and change indicators where applicable.
Observed values for Payment Type include APC, FS, NO; Fee Schedule Type examples include LAB and ANES. Fee schedule amounts are provided for some lab codes (example: 0123U fee 339.75).
Max Units may be specified for some codes (examples: many lab temporary U-codes show Max Units = 1; 0224U shows Max Units = 3).
Per-code payment/authorization nodes
Per-code administrative/payment criteria visible in this excerpt:
0087U — Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; Iowa Medicaid PA IND = R; Fee Schedule Amount = 3001.45; Fee Schedule Type = LAB.
00908 — Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 90; Iowa Medicaid PA IND = N; Fee Schedule Type = ANES.
0095T — Payment Type = APC; Iowa Medicaid Max Units = 1; Iowa Medicaid PA IND = R (restricted/PA-required).
0098T — Payment Type = APC; Iowa Medicaid Max Units = 2; Iowa Medicaid PA IND = R (restricted/PA-required).
Coverage and billing rules (per-code)
Coverage stance and billing rules are represented per-code in the addendum entries; examples below illustrate attributes providers must follow when billing:
APC-paid codes include APC Status Indicator values (e.g., N, Q1, Q4, J1) which influence hospital outpatient APC grouping and billing; billers should use the APC fields shown for claim classification.
Iowa Medicaid PA IND indicates prior authorization requirements per code (examples shown with values N or R); where PA IND = R, prior authorization or review is required before payment.
Administrative billing/payment fields
Billing/payment stance and administrative fields present in lines:
Each line indicates the 'Iowa Medicaid Payment Type' (APC, FS, NO) showing how the item is paid on claims; many anesthesia lines are APC-paid with APC Status Indicator = N.
APC Status Indicator values reported include N, A, C, Q4, J1 and others — these classify APC assignment or special status for outpatient grouping.
Fee schedule amounts are present for some lab/FS codes (examples in this excerpt: 0123U = 339.75; 0172U = 2878.5), while many procedure/APC lines show blank fee amounts in this extract.
Anesthesia Base Unit numeric values appear on certain anesthesia fee rows (examples: 120, 180) and are used for anesthesia payment calculations.
Iowa Medicaid PA IND is present per-line (commonly N or blank in many anesthesia/APC rows), indicating whether prior authorization is required for that code.
Fee schedule entries
Billing/payment metadata for listed codes
Fee-schedule entries list a wide set of metadata fields including Short Descriptor, Iowa Medicaid Payment Type, APC Status Indicator, APC numeric assignment (when present), APC Relative Weight (when present), Iowa Medicaid Max Units, Iowa Medicaid PA IND, Control Code, Anesthesia Base Unit, Fee Schedule Amount, and Fee Schedule Type; some FS/LAB rows include explicit fee amounts and PA IND = R.
Fee schedule billing metadata
Billing/payment guidance visible in these lines
The addendum provides line-item billing metadata; providers should rely on the listed Payment Type, APC Status Indicator, APC and Relative Weight (where provided), Max Units, PA IND, and Fee Schedule Amount/Type to determine billing classification and expected reimbursement treatment for each code.
Billing/classification rules (administrative)
Administrative billing stance for listed codes in this segment
Lines within this segment (chunks 180–199) show items with Payment Type values APC or NO, APC Status Indicators (e.g., N, A, C, Q1), APC numeric assignments and Relative Weights for certain codes, and per-line PA IND values (commonly N or blank) — use these fields for administrative classification on claims.
Examples of payment entries
Payment/coverage stance for listed codes
Example: 0202U — Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; Iowa Medicaid PA IND = N; Iowa Medicaid Fee Schedule Amount = 395.94; Fee Schedule Type = LAB. Providers should bill using the listed fee and observe Max Units.
Laboratory code coverage examples
Examples of coverage/billing stance drawn from listed codes:
0223U — Iowa Medicaid Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; Iowa Medicaid PA IND = N; Iowa Medicaid Fee Schedule Amount = 395.94; Fee Schedule Type = LAB.
0224U — Iowa Medicaid Payment Type = FS; Iowa Medicaid Max Units = 3; Iowa Medicaid PA IND = N; Fee Schedule Amount = 48.86; Fee Schedule Type = LAB.
Restricted / PA-required lab codes
Codes requiring prior authorization (PA IND = R) or flagged as restricted:
Procedure APC/bundling examples
Examples of procedure/operative T-codes with APC assignments and relative weights (billing rules apply per APC):
Fee schedule entry metadata (informational)
No explicit coverage criteria or medical necessity rules are included in these chunks. The entries are fee-schedule rows with payment and APC metadata.
Informational: rows list short descriptor, payment type, APC status, APC values, APC Relative Weight, fee schedule amount/type, PA indicator and other administrative fields; the extract contains no narrative clinical coverage or medical necessity criteria.
Fee-schedule data structure (informational)
No explicit coverage criteria are stated in these chunks; entries include fields for Payment Type, APC Status Indicator, APC, APC Relative Weight, Max Units, PA IND, Control Code, Fee Schedule Amount, and flags for changes.
Data-structure view: each fee-schedule line contains fields for code, short descriptor, Iowa Medicaid Payment Type, APC Status Indicator, APC numeric assignment, APC Relative Weight, Iowa Medicaid Max Units, Iowa Medicaid PA IND, Iowa Medicaid Fee Schedule Amount, Iowa Medicaid Fee Schedule Type, Iowa Medicaid Control Code, Iowa Medicaid Anesthesia Base Unit, and change metadata (Change Type Indicator and Effective Date of Change) where applicable.
Code Listings and Examples
Examples with explicit fee or anesthesia base unitsmixedCovered
Sample listed codes (partial)mixedCovered
| 0016U | Laboratory/genetic code listed with Fee Schedule Amount = 155.76 and Fee Schedule Type = LAB |
| 00170 | Anes intraoral procedure (Short Descriptor = Anes intraoral px nos; Payment Type = APC; APC Status Indicator = N; PA IND = N) |
| 0029U | Rx metab advrs trgt seq alys (APC Status Indicator = D; marked as changed with Effective Date = 2026-07-01; Change Type Indicator = 5) |
Additional codes (partial)mixedCovered
| 0031U | Cyp1a2 gene (APC Status Indicator = D; marked as changed with Effective Date = 2026-07-01; Change Type Indicator = 5) |
| 00320 | Anes all px neck nos 1yr/> (Payment Type = APC; APC Status Indicator = N; PA IND = N) |
| 00326 | Anes all px larynx & trach <1yr (Payment Type = APC; APC Status Indicator = N; PA IND = N) |
Sample codes present in excerptmixed
Anesthesia base-unit entriesCPTCovered
| 00560 | Anes px heart w/o pump oxtj (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 225; Fee Schedule Type = ANES) |
| 00561 | Anes px heart w/pump<1 yr (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 375; Fee Schedule Type = ANES) |
| 00562 | Anes px hrt w/pump age 1yr+ (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 300; Fee Schedule Type = ANES) |
sample anesthesia CPT/APC entriesCPTCovered
| 00792 | Anes iper upr abd prtl hptc (Iowa Medicaid Anesthesia Base Unit = 195; Fee Schedule Type = ANES) |
| 00794 | Anes iper upr abd pncrtect (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 120; Fee Schedule Type = ANES) |
| 00866 | Anes xtrprt lw abd adrnlctmy (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 150; Fee Schedule Type = ANES) |
Notable entries with anesthesia base units or fee amountsmixedCovered
| 0087U | Crd hrt trnspl mrna 1283 gen (Fee Schedule Type = LAB; Fee Schedule Amount = 3001.45; Iowa Medicaid Max Units = 1; PA IND = R) |
| 00908 | Anes perineal prostatectomy (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 90; Fee Schedule Type = ANES) |
| 00932 | Anes male gent compl amp pns (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 60; Fee Schedule Type = ANES) |
| 00936 | Anes rad amp pns ingun&ilac (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 120; Fee Schedule Type = ANES) |
sample covered codes and attributesmixedCovered
| 0095T | Rmvl artific disc addl crvcl (Payment Type = APC; APC Status Indicator = N; Iowa Medicaid Max Units = 1; PA IND = R) |
| 0098T | Rev artific disc addl (Payment Type = APC; APC Status Indicator = N; Iowa Medicaid Max Units = 2; PA IND = R) |
| 0107U | C diff tox ag detcj ia stool (Payment Type = APC-FS; APC Status Indicator = Q4; Iowa Medicaid Max Units = 1; PA IND = N; Fee Schedule Amount = 15.2; Fee Schedule Type = LAB) |
| 0111U | Onc colon ca kras&nras alys (Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 648.18; Fee Schedule Type = LAB) |
| 0113U | Onc prst8 pca3&tmprss2-erg (Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 722; Fee Schedule Type = LAB) |
| 0120U | Onc b cll lymphm mrna 58 gen (Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 2384.7; Fee Schedule Type = LAB) |
Laboratory code exampleHCPCSCovered
| 0123U | Mchnl fragility rbc prflg (Fee Schedule Amount = 339.75; Fee Schedule Type = LAB; Iowa Medicaid Max Units = 1) |
Anesthesia examples with base unitsmixedCovered
Selected FS/ANES/LAB codes with units, PA, and feesmixedCovered
| 01502 | Anes px art lower leg emblc (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 90; Fee Schedule Type = ANES) |
| 0157U | Apc mrna seq alys (Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 268.74; Fee Schedule Type = LAB) |
| 0158U | Mlh1 mrna seq alys (Payment Type = FS; APC Status Indicator = A; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 268.74; Fee Schedule Type = LAB) |
| 0162U | Hered colon ca trgt mrna pnl (Payment Type = FS; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 462.21; Fee Schedule Type = LAB) |
| 01652 | Anes art sho&ax ax-brch arsm (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 150; Fee Schedule Type = ANES) |
| 01654 | Anes art sho&ax bypass grf (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 120; Fee Schedule Type = ANES) |
| 01656 | Anes art sho&ax ax-fem bpg (Payment Type = FS; APC Status Indicator = C; Iowa Medicaid Anesthesia Base Unit = 150; Fee Schedule Type = ANES) |
sample listed codes with payment metadatamixedCovered
Sample codes and APC details from this segmentCPT
| 0198T | Ocular blood flow measure (APC = 5734; APC Relative Weight = 1.487) |
| 01990 | Physiol support hrvg organs (Payment Type = NO; APC Status Indicator = C) |
Selected APC and fee-schedule entriesmixedCovered
| 0200T | Perq sacral augmt unilat inj (Payment Type = NO; APC Status Indicator = J1; APC = 5114; APC Relative Weight = 81.0959) |
| 0201T | Perq sacral augmt bilat inj (APC Status Indicator = J1; APC = 5114; APC Relative Weight = 81.0959) |
| 0202T | Post vert arthrplst 1 lumbar (Payment Type = NO; APC Status Indicator = J1; APC = 5115; APC Relative Weight = 143.4859) |
| 0202U | Nfct ds 22 trgt sars-cov-2 (Payment Type = FS; Fee Schedule Amount = 395.94; Iowa Medicaid Max Units = 1; PA IND = N; Fee Schedule Type = LAB) |
Placement post facet implant series (T codes)mixed
| 0219T | Plmt post facet implt cerv (Payment Type = NO; APC Status Indicator = J1; APC = 5115; APC Relative Weight = 143.4859) |
| 0220T | Plmt post facet implt thor (Payment Type = NO; APC Status Indicator = J1; APC = 5115; APC Relative Weight = 143.4859) |
| 0221T | Plmt post facet implt lumb (Payment Type = NO; APC Status Indicator = J1; APC = 5114; APC Relative Weight = 81.0959) |
Laboratory-specific temporary codes (U codes)HCPCSCovered
| 0223U | Nfct ds 22 trgt sars-cov-2 (Fee Schedule Amount = 395.94; Iowa Medicaid Max Units = 1; PA IND = N; Fee Schedule Type = LAB) |
| 0224U | Antibody sars-cov-2 titer(s) (Fee Schedule Amount = 48.86; Iowa Medicaid Max Units = 3; PA IND = N; Fee Schedule Type = LAB) |
| 0251U | Hepcidin-25 ELISA serum/plsm (Fee Schedule Amount = 16.41; Iowa Medicaid Max Units = 1; PA IND = N; Fee Schedule Type = LAB) |
| 0252U | Fetal aneuploidy STR analysis DNA (Fee Schedule Amount = 721.1; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Type = LAB) |
sample entries (partial list)mixedCovered
| 0252U | aneuploidy str alys dna (Payment Type = FS; Fee Schedule Amount = 721.1; Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Type = LAB) |
| 0253T | Insert aqueous drain device (Payment Type = NO; APC Status Indicator = J1; APC = 5492; APC Relative Weight = 46.1954) |
| 0263T | Im b1 mrw cel ther cmpl (APC Status Indicator = S; APC = 5243; APC Relative Weight = 48.6774) |
| 0264T | Im b1 mrw cel ther xcl hrvst (APC Status Indicator = S; APC = 5243; APC Relative Weight = 48.6774) |
| 0274T | Prq lamot/lam dcmpr crv/thrc (APC Status Indicator = J1; APC = 5114; APC Relative Weight = 81.0959) |
| 0278T | Tempr. (APC Status Indicator = Q1; APC = 5721; APC Relative Weight = 1.4381) |
sample listed codesmixed
| 0287U | Onc lung mrna quan pcr 11&3 (Payment Type = NO) |
| 0288U | Neuro alzheimer mrna 24 gen (Payment Type = NO) |
| 0308T | Insj ocular telescope prosth (APC Status Indicator = J1; APC = 5496; APC Relative Weight = 183.9672) |
| 0330T | Tear film img uni/bi w/i&r (APC = 5732; APC Relative Weight = 0.4174) |
| 0331T | Heart symp image plnr (APC = 5593; APC Relative Weight = 14.4691) |
Iowa Medicaid Max Units example
Example code0016U — Iowa Medicaid Max Units = 1
Fee schedule amount0016U — Fee Schedule Amount = 155.76
Fee schedule type0016U — Fee Schedule Type = LAB
Effective change date present
Effective change date0029U and 0031U — Effective Date of Change = 2026-07-01 00:00:00
Change type indicator0029U — Change Type Indicator = 5; 0031U — Change Type Indicator = 5
Marked as changedBoth codes are indicated with '*' (change from previous quarter) in the addendum
Iowa Medicaid Max Units (example)
Example code0040U — Iowa Medicaid Max Units = 1
Fee schedule amount0040U — Fee Schedule Amount = 389.41
Fee schedule type0040U — Fee Schedule Type = LAB
Iowa Medicaid Max Units
General noteIowa Medicaid Max Units often blank when not applicable; examples present in listing
Specific example0069U — Iowa Medicaid Max Units = 1
Associated PA IND0069U — PA IND = R
Iowa Medicaid Max Units example
Example code0084U — Iowa Medicaid Max Units = 1
Fee schedule amount0084U — Fee Schedule Amount = 684
PA indicator0084U — PA IND = R
Iowa Medicaid Max Units (examples)
0095TIowa Medicaid Max Units = 1; Iowa Medicaid PA IND = R
0098TIowa Medicaid Max Units = 2; Iowa Medicaid PA IND = R
ContextBoth codes are APC-paid procedure entries listing Max Units and PA IND indicating restricted/PA-required
Iowa Medicaid Max Units
Example code0123U — Iowa Medicaid Max Units = 1
Fee schedule amount0123U — Fee Schedule Amount = 339.75
Fee schedule type0123U — Fee Schedule Type = LAB
Iowa Medicaid Max Units (examples)
0164TIowa Medicaid Max Units = 4; PA IND = R
0165TIowa Medicaid Max Units = 4; PA IND = R
Lab codesSeveral LAB codes in this segment list Max Units = 1 (examples provided elsewhere) — when present they are specified per code
Iowa Medicaid Max Units examples
Common patternMany entries show Iowa Medicaid Max Units blank; some list Max Units = 1
Example code0172U — Iowa Medicaid Max Units = 1; Fee Schedule Amount = 2878.5; PA IND = N
Procedure example0184T — Iowa Medicaid Max Units = 1; APC = 5331; APC Relative Weight = 67.8487
APC Relative Weight example
APC relative weight example0198T — APC Relative Weight = 1.487
APC context0198T — APC = 5734; APC Status Indicator present
NoteRelative weight values appear alongside APC assignments for some procedure codes
Max units (example)
Example code0202U — Iowa Medicaid Max Units = 1
Fee schedule amount0202U — Fee Schedule Amount = 395.94
PA indicator0202U — PA IND = N
Iowa Medicaid Max Units examples
Multiple lab examplesSeveral codes list Iowa Medicaid Max Units = 1 (e.g., 0223U, 0225U, 0238U, 0251U, 0252U)
Exception0224U — Iowa Medicaid Max Units = 3 (Antibody SARS‑CoV‑2 titer)
Associated feesExamples include fee amounts: 0223U/0225U = 395.94; 0238U = 555.66; 0252U = 721.1
Iowa Medicaid Max Units
General observationIowa Medicaid Max Units field is often blank or not specified for many entries in the addendum
Specific example0252U — Iowa Medicaid Max Units = 1; PA IND = R; Fee Schedule Amount = 721.1
Fee schedule type0252U — Fee Schedule Type = LAB
APC-relative-weight examples
High RW example0308T — APC Relative Weight = 183.9672
Low RW example0330T — APC Relative Weight = 0.4174
Mid RW example0331T — APC Relative Weight = 14.4691
Prior Authorization and Billing Actions Providers Must Take
Documentation Required
Anesthesia codes show PA IND = N
Many anesthesia procedure codes list an Iowa Medicaid PA IND value of N (no prior authorization required) on the fee-schedule lines (examples include 00100, 00102, 00103).
- PA IND field is present per line and is set to N for these anesthesia codes.
Documentation Required
00176: ANES fee type and base unit present
Code 00176 is listed with Iowa Medicaid PA IND = N and shows Fee Schedule Type = ANES plus an Iowa Medicaid Anesthesia Base Unit value of 105.
- Payment Type = FS; Fee Schedule Type = ANES; Anesthesia Base Unit = 105; PA IND = N.
Billing Rule
00176 lists Payment Type = FS and Anesthesia Base Unit = 105
The fee-schedule entry for 00176 explicitly notes Iowa Medicaid Payment Type = FS and an Iowa Medicaid Anesthesia Base Unit = 105; billers must use the stated payment type and base unit when calculating anesthesia-related claims.
- Iowa Medicaid Payment Type = FS
- Iowa Medicaid Anesthesia Base Unit = 105
Documentation Required
PA IND field present; many anesthesia rows = N
Fee-schedule rows include an 'Iowa Medicaid PA IND' field and many anesthesia-related rows are set to N (no prior authorization); some lab or special-procedure rows show PA IND = R or are blank.
- PA IND field present on each line
- Anesthesia rows commonly show PA IND = N
- Some lab entries show PA IND = R or blank
Documentation Required
PA indicator field appears on line items (many = N)
The fee-schedule export contains an 'Iowa Medicaid PA IND' field on many line items; several anesthesia and other service lines are set to 'N' indicating no prior authorization is required.
- PA IND appears as a discrete field on line items
- Multiple lines set PA IND = N
Documentation Required
PA indicators specified per fee line
Each line item in the addendum includes an 'Iowa Medicaid PA IND' field; many anesthesia and APC lines show PA IND = N or are left blank, indicating the prior authorization indicator is specified per line.
- PA IND shown per line (values N or blank)
- Providers should read the PA IND value on each fee-line before billing.
Prior Authorization
PA indicators shown alongside Max Units
Certain fee lines list both a PA indicator and an Iowa Medicaid Max Units value; for example 0095T (PA IND = R, Max Units = 1) and 0098T (PA IND = R, Max Units = 2).
- Max Units are enforced where listed
- PA IND = R indicates review/authorization required for those unit limits.
Documentation Required
Check PA IND on each fee-schedule row
Fee-schedule lines explicitly list an 'Iowa Medicaid PA IND' value per row (most anesthesia/APC lines show N or are blank) — providers must check the PA IND on each fee-row when preparing claims.
- PA IND value appears on each fee-row
- Most shown values in this excerpt are N or blank
Prior Authorization
Listed LAB/FS codes require PA (PA IND = R)
Several laboratory and FS-coded entries are marked PA IND = R, indicating prior authorization/review is required; examples include 0157U–0162U which list PA IND = R and include fee amounts for several codes.
Documentation Required
Anesthesia/APC lines commonly PA IND = N
Many anesthesia/APC line items are shown with Iowa Medicaid PA IND = N (no prior authorization required) in the fee rows — for example 01730 and related anesthesia entries show PA IND = N.
- 01730 and nearby anesthesia APC lines: PA IND = N
- Providers should rely on the PA IND shown for each anesthesia line.
Documentation Required
PA indicators appear in APC listings (often N or blank)
APC and fee-schedule listings include PA indicator values (many show PA IND = N or blank); providers must review APC listings for the PA IND before billing.
- APC listings include PA IND field
- Values observed include N or blank in this excerpt
Billing Rule
0251U: Hepcidin‑25 ELISA — PA IND = N
0251U (Hepcidin‑25 ELISA) is listed with Iowa Medicaid PA IND = N, Max Units = 1, Fee Schedule Amount = 16.41, and Fee Schedule Type = LAB.
- 0251U: PA IND = N; Max Units = 1; Fee = 16.41; Fee Type = LAB
Prior Authorization
0252U requires prior authorization (PA IND = R)
0252U (fetal aneuploidy STR analysis DNA) is listed with Iowa Medicaid PA IND = R, Iowa Medicaid Max Units = 1, Fee Schedule Amount = 721.1, and Fee Schedule Type = LAB — prior authorization is required for this code.
- 0252U: PA IND = R; Max Units = 1; Fee = 721.1; Fee Type = LAB
Prior Authorization
0238U requires prior authorization (PA IND = R)
0238U (oncologic gene sequencing DNA analysis) is listed with Iowa Medicaid PA IND = R, Max Units = 1, Fee Schedule Amount = 555.66, and Fee Schedule Type = LAB — this code requires prior authorization.
- 0238U: PA IND = R; Max Units = 1; Fee = 555.66; Fee Type = LAB
Documentation Required
PA IND and Payment Type metadata present per entry
Many fee-schedule entries include PA indicator and payment type metadata (e.g., values for Iowa Medicaid PA IND and Iowa Medicaid Payment Type such as FS or NO); providers should rely on those fields in the addendum for payment classification.
- PA IND and Payment Type fields are present together in entries
- Payment Type examples: FS, NO
Note
Fee schedule includes PA IND field on each line
The fee-schedule export includes an 'Iowa Medicaid PA IND' field for line items (the field appears in the listing even where shown as '.' or blank) — providers must reference the PA IND column in the fee schedule when determining authorization requirements.
- PA IND field exists for each line in the export
- Some PA IND values appear as '.' or blank in the extract
Key fields and Abbreviations
Addendum B
Document nameAddendum B — Iowa Medicaid CY2026 supplemental listing of CPT/HCPCS and related codes
PurposeProvides codes with Iowa Medicaid payment attributes (Payment Type, APC Status Indicator, APC, Relative Weight, Max Units, PA IND, Control Code, Anesthesia Base Unit, Fee Schedule Amount/Type, change indicators)
Effective updateUpdated for July 1, 2026 (document header)
PA IND
DefinitionPA IND — Prior authorization indicator as listed alongside codes (values seen include N, R, or blank)
Example value meaningsN = No prior authorization; R = Requires review/prior authorization; blank = not specified
Field presencePA IND is provided per fee-schedule line item where applicable
PA IND
PA IND in fee schedulePA IND values appear on fee-schedule lines (examples include N or R or blank)
Code example00170 — PA IND = N; 00176 — PA IND = N
UsageIndicates whether prior authorization is required for the listed code
Iowa Medicaid Anesthesia Base Unit
DefinitionIowa Medicaid Anesthesia Base Unit — numeric base units assigned to anesthesia procedure codes
Examples00176 — Anesthesia Base Unit = 105; 00211 — Anesthesia Base Unit = 150; 00214/00215 — examples include 135
UseBase unit values are listed where applicable for anesthesia fee calculations
ANES
ANES fee schedule typeANES — Fee Schedule Type used for anesthesia-related entries that include Anesthesia Base Units
Example00540 — Anesthesia Base Unit = 180; Fee Schedule Type = ANES
PresenceANES appears in rows with anesthesia base unit values
Iowa Medicaid PA IND
PA IND examplesMany anesthesia procedure codes list PA IND = N (no prior authorization) — see anesthesia entries in the addendum
Anesthesia payment typeSome anesthesia lines show Payment Type = FS along with Anesthesia Base Unit (e.g., 00176)
Provider implicationProviders should note PA IND per line when submitting claims for anesthesia services
Prior Authorization Indicator
Field namePrior Authorization Indicator (Iowa Medicaid PA IND)
Values seenN, R, or blank (N = no prior authorization; R = requires review/prior authorization)
Appears onFee-schedule line items for various code types (anesthesia, lab, APC entries)
Anesthesia base units used in fee schedule calculation
Use in fee scheduleAnesthesia Base Units are included in fee-schedule calculation where applicable
Examples00560 — Base Unit 225; 00561 — Base Unit 375; 00524 — Base Unit 60
Fee typeAnesthesia Base Units accompany Fee Schedule Type = ANES for anesthesia entries
PA IND
PA IND valuesPA IND entries appear as N, R, or blank across fee rows — examples include codes flagged with R or N
Changed codes0029U and 0031U show change indicators and have PA IND fields present (may be blank)
Provider actionCheck PA IND on the fee row to determine prior authorization requirement before billing
Anesthesia Base Unit
Anesthesia base units (examples)00561 — 375; 00560 — 225; 01652 — 150
Associated payment typeThese entries frequently show Payment Type = FS and Fee Schedule Type = ANES
APC/FS distinctionAnesthesia entries may be classified as APC or FS depending on the line item
Fee Schedule Type
DefinitionFee Schedule Type — denotes category applied to line (examples: LAB, ANES, FS, NO)
Example0123U — Fee Schedule Type = LAB; 01272 — Fee Schedule Type = ANES
ImplicationFee Schedule Type indicates how the code will be priced or grouped for payment
PA IND = R (requires review/prior authorization)
PA IND — RPA IND = R indicates the code requires review/prior authorization (examples: many LAB codes such as 0157U, 0158U)
Examples0157U, 0158U, 0111U — listed with PA IND = R in the fee-schedule entries
ActionProviders should obtain prior authorization where PA IND = R before billing
Fee Schedule Type
Fee schedule categoriesFee Schedule Type values include LAB and ANES for laboratory and anesthesia entries respectively
Examples0157U — Fee Schedule Type = LAB; 01652/01654 — Fee Schedule Type = ANES
UseIndicates the fee category applied when fee amounts are present
Iowa Medicaid PA IND
TerminologyIowa Medicaid PA IND — prior authorization indicator field shown per code line
PresenceField appears across anesthesia, lab, APC and NO payment-type lines
ValuesN, R, or blank as applicable
APC Status Indicator
APC Status IndicatorAPC Status Indicator values appear per line (examples include A, N, J1, Q4)
Examples0184T — APC Status Indicator = J1; many anesthesia/APC lines show N or C
ImplicationAPC Status affects outpatient APC grouping and billing classification
Iowa Medicaid PA IND
PA IND fieldIowa Medicaid PA IND is included across APC listings and other fee rows (values often N or blank)
Provider reminderCheck the PA IND value on APC/fee lines to confirm prior authorization requirements
APC linesMany APC entries list PA IND = N indicating no prior authorization required for those APC codes
Anesthesia Base Unit
Anesthesia Base UnitField 'Iowa Medicaid Anesthesia Base Unit' present where applicable for anesthesia codes
ExamplesSeveral entries list base units alongside Payment Type and APC status (see anesthesia sections)
UsageUsed in fee calculation for anesthesia fee-schedule entries
Fee Schedule Type
Fee Schedule Type examplesFee Schedule Type values include LAB, ANES, FS, NO as shown on line items
Code examples0157U — FS/LAB; 01652 — ANES; 00176 — ANES
SignificanceFee Schedule Type defines the category for pricing and provider billing
Iowa Medicaid PA IND
PA IND entriesPA IND values (N, R, blank) are listed per code in the fee-schedule export
Changed codes note0029U and 0031U are marked as changed and include PA IND fields potentially updated
Provider actionReview PA IND on changed codes for updated prior authorization requirements
APC Status Indicator
APC Status examplesAPC Status Indicator values shown include A, N, Q4, J1 among others
Example codes0184T — J1; many APC lines show N or C depending on classification
EffectAPC Status Indicator informs grouping and hospital outpatient payment handling
Iowa Medicaid PA IND
PA IND example0202U — PA IND = N (no prior authorization required)
Max Units0202U — Max Units = 1
Fee amount0202U — Fee Schedule Amount = 395.94; Fee Schedule Type = LAB
Iowa Medicaid PA IND
PA IND per codeIowa Medicaid PA IND is listed per code line in the addendum (values N, R, blank)
Fee schedule typeFee Schedule Type appears alongside PA IND (e.g., LAB entries often show PA IND and fee amounts)
Provider noteUse the per-code PA IND to determine if prior authorization is required before submitting claims
Iowa Medicaid Payment Type
Payment TypeIowa Medicaid Payment Type — values include FS and NO as shown on line items
Example0252U — Payment Type = FS
ImplicationPayment Type indicates payer classification for fee schedule/payment handling
APC Status Indicator
APC Status Indicator definitionAPC Status Indicator — outpatient APC category indicator (examples: J1, S, A, Q4, Q1)
Example usage0253T — APC Status Indicator = J1; 0308T — J1
RoleUsed to classify APC grouping and special statuses for outpatient services
Iowa Medicaid Fee Schedule Amount
Fee schedule amountIowa Medicaid Fee Schedule Amount — dollar amount when provided on code line
Example0252U — Fee Schedule Amount = 721.1; 0238U — Fee Schedule Amount = 555.66
NoteNot all lines include a fee amount; many APC/NO lines leave fee blank in this export
Iowa Medicaid PA IND
PA IND field presenceThe Iowa Medicaid PA IND field is present in the fee-schedule export for line items (may show values or be blank)
DisplaySome exported rows show a '.' or blank indicating no PA IND value provided
Provider actionConfirm PA IND per line when checking authorization requirements
APC Status Indicator
APC Status Indicator valuesAPC Status Indicator values include examples A, Q4, E1, J1, Q1, S in the listing
Examples with APCs0308T — APC=5496 (J1); 0330T — APC=5732 (Q1); 0331T — APC=5593
UseThese values indicate APC grouping and special handling for outpatient payments
Iowa Medicaid Fee Schedule Amount
Payment type fieldIowa Medicaid Fee Schedule Type field indicates category (e.g., LAB, ANES, APC-FS) and appears when fee amounts are shown
Example0251U — Fee Schedule Type = LAB; 00176 — Fee Schedule Type = ANES
ImplicationFee Schedule Type complements Payment Type to classify fee rows
Iowa Medicaid PA IND
PA IND presence per codeIowa Medicaid PA IND is provided next to codes in the addendum (values N, R, blank) and should be checked per code
Changed-code indicatorSome codes flagged with '*' also include PA IND field entries which may have been updated
Provider implicationCheck updated lines for any change in PA IND before billing
APC Status Indicator
APC Status Indicator examplesAPC Status Indicator values (A, Q4, E1, J1, Q1, S) are used across APC lines in the addendum
APC numeric assignmentsSome lines include APC numeric values and corresponding Relative Weights (examples in chunks 261, 270, 271)
PurposeThese indicators guide APC grouping and payment calculations for outpatient claims
Policy Summary
PayerIowa Department of Health and Human Services
PolicyIowa Medicaid CY2026 Addendum B — CPT/HCPCS code listing and payment attributes
Policy CodePolicy N/A
Change TypeCodes added/flagged (0029U, 0031U)
Effective DateJul 1, 2026
Last ReviewJul 1, 2026
Next Review Date
Key ActionWhen billing, use the listed Iowa Medicaid Payment Type, APC Status Indicator, Fee Schedule Amount/Type, Max Units, and PA IND fields for each code.
SourceLink
On This Page
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.