MedicaidReimbursementHigh impact
Asked Questions (FAQ): Connecticut Maternity Bundle Billing and Claims
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Connecticut has updated its Medicaid Maternity Bundle Payment Program for Performance Year 2, transitioning from fee-for-service to episode-based bundled payments for maternity care. Eligible providers performing 30+ annual deliveries will receive monthly case rate payments for most maternity services, with specific trigger criteria and billing requirements.
Action Required
Immediately: Billing teams for eligible Connecticut Medicaid maternity providers must update billing systems to recognize trigger event criteria using E&M codes 99202-99205 and 99212-99215 with qualifying diagnosis codes and place of service 11, 19, or 22. Configure systems to zero-pay case rate covered services after trigger events and set up monthly case rate payment processing. Review the complete Case Rate Codes and Reconciliation Codes lists on the DSS website to properly categorize services. Failure to properly implement these changes will result in incorrect payments and reconciliation issues.