MedicaidCoverageHigh impact
2025.34 - Provider Bulletin - Policy Updates and Changes to Clinical Review Criteria
Connecticut Medicaid (HUSKY Health)·CT · Oral & Maxillofacial Surgery, ENT (Ear, Nose & Throat), Neurology +5 more·Provider Bulletin
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is implementing new clinical review criteria for multiple medical services and devices effective August 1, 2025, including new policies for neuromuscular stimulation devices, orthognathic surgery, TMJ procedures, and several gene therapies. Several existing policies are being retired and will transition to InterQual criteria, while numerous other policies are being updated.
Action Required
By August 1, 2025: Billing team must review and implement new prior authorization requirements for neuromuscular electrical stimulation devices, orthognathic surgery, TMJ procedures, and gene therapies. Update billing system to reflect that HCPCS code E0469 (Volara System) is no longer reimbursable. Stop submitting claims for retired policies including orthoses for pectus carinatum, C-Brace devices, and anti-embolism stockings under old criteria - these will now use InterQual criteria. Access updated policies at https://portal.ct.gov/husky under Medical Management menu.