MedicaidPrior AuthHigh impact
*September 2025 InterChange Newsletter - Revised*
Connecticut Medicaid (HUSKY Health)·CT · Family Medicine, Internal Medicine, Endocrinology +1 more·Provider Bulletin
Effective date
Dec 15, 2024
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has issued multiple policy updates including new diagnosis requirements for GLP-1 medications (must have Type 2 diabetes), coverage for Zepbound for obstructive sleep apnea with prior authorization requirements, and updated influenza vaccine billing requirements for the 2025-2026 flu season.
Action Required
Immediately: 1) Update billing system to require Type 2 diabetes ICD-10 codes in field 424-DO for all GLP-1 medications (Ozempic, Mounjaro, Trulicity, etc.) - claims will be denied without proper diagnosis. 2) For Zepbound OSA prescriptions starting July 1, 2025: billing team must verify prior authorization is obtained and diagnosis code G47.33 is included in field 424-DO. 3) Update flu vaccine billing to ensure correct HCPCS codes match NDC numbers for 2025-2026 season - mismatched codes will result in denials. 4) Stop billing administration fees for vaccines obtained free through Connecticut Vaccine Program.