MedicaidBilling CodesHigh impact
2025.76 - Provider Bulletin - Cell and Gene Therapy for Sickle Cell Disease - Revised 12.18.2025
Connecticut Medicaid (HUSKY Health)·CT · Hematology, Oncology·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY Health) establishes new billing procedures for cell and gene therapy treatments for Sickle Cell Disease under the CMS CGT Access Model. Hospitals must bill CGT products separately on outpatient claims using specific HCPCS codes and obtain separate prior authorizations for both the CGT product and inpatient admission.
Action Required
Before January 1, 2026: Billing team must update system to bill CGT products (Casgevy J3392 and Lyfgenia J3394) on outpatient claims using Revenue Center Code 0891, never on inpatient claims. Set up dual prior authorization workflow requiring separate PAs for both CGT product and inpatient admission. Train staff that reimbursement is based on CMAP Addendum B rates or actual acquisition cost, whichever is higher. Update procedures to exclude 340-B discounts for these inpatient-administered drugs.