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Connecticut Medicaid (HUSKY Health)Medicaid · Coverage · Provider Bulletin · CT · Oral & Maxillofacial Surgery, ENT (Ear, Nose & Throat), Neurology +5 moreHigh impact

2025.34 - Provider Bulletin - Policy Updates and Changes to Clinical Review Criteria

Act
by Aug 1, 2025
Effective date
Aug 1, 2025
Identified
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.

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What to do

by Aug 1, 2025 · 4 steps
01Billing team must review and implement new prior authorization requirements for neuromuscular electrical stimulation devices, orthognathic surgery, TMJ procedures, and gene therapies.
02Update billing system to reflect that HCPCS code E0469 (Volara System) is no longer reimbursable.
03Stop 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.
04Access updated policies at https://portal.ct.gov/husky under Medical Management menu.

Codes mentioned

E0469

Original notice

2025.34 - Provider Bulletin - Policy Updates and Changes to Clinical Review Criteria
ctdssmap.com · Always check the source before changing claims.
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Related policy hubs

Connecticut Medicaid (HUSKY Health) policiesCT policy changesOral & Maxillofacial SurgeryENT (Ear, Nose & Throat)NeurologyPM&R (Physical Medicine & Rehab)Physical TherapyOccupational TherapyOrthopedicsOncologyCode E0469

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