MedicaidReimbursementHigh impact
DSS Important Message - FAQ Connecticut Maternity Bundle Billing & Claims 05.29.2025
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN·Provider Bulletin
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has implemented a mandatory Maternity Bundle Payment Program starting January 1, 2025, transitioning eligible maternity providers (30+ annual deliveries) from fee-for-service to monthly case rate payments during the maternity episode (280 days pre-delivery to 90 days post-delivery). Key billing changes include trigger events requiring specific E&M codes and diagnosis codes, with affected services zero-paying and reimbursed through monthly case rates instead.
Action Required
Immediately: Maternity providers with 30+ annual deliveries must update billing workflows to accommodate zero-pay claims for case rate services. Billing team must verify trigger event criteria are met when submitting claims with E&M codes 99202-99205 and 99212-99215 combined with qualifying diagnosis codes. Update billing system to expect monthly case rate payments in first payment cycle of following month instead of individual service payments. Review DSS website code lists for complete Case Rate Codes and Reconciliation Codes to properly identify which services will zero-pay versus FFS payment.