MedicaidAdministrativeMedium impact
2026.25 - Provider Bulletin - Claim Submission Changes for the Identification of Children with an Individualized Education Plan
Connecticut Medicaid (HUSKY Health)·CT · Pediatrics·Coding
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Starting July 1, 2026, Connecticut school-based child health providers must add specific modifiers (TM for children with IEP, TR for children without IEP) to all Medicaid SBCH service claims. This requirement applies to all school districts billing Medicaid for special education-related health services.
Action Required
By July 1, 2026: School-based child health billing teams in Connecticut must update billing systems to require modifier TM for services provided to children with an Individualized Education Plan (IEP) or modifier TR for services to children without an IEP on all SBCH Medicaid claims. Update claim submission workflows and train staff on proper modifier assignment. Claims without required modifiers may be denied.