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MedicaidReimbursementMedium impact

2024.82 - Provider Bulletin - Updates to the Reimbursement Rate for Select Long-Acting Reversible Contraceptive Device

Connecticut Medicaid (HUSKY Health)·CT · OB-GYN, Family Medicine, Internal Medicine·Reimbursement
Effective date
Jan 2, 2025
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid (CMAP) is updating the reimbursement rate for etonogestrel contraceptive implants (J7307) to $1,214.63 for physician offices and outpatient settings. Different reimbursement rules apply for FQHCs and hospitals based on their specific fee schedules.

Action Required

Action needed
By January 2, 2025: Billing team must update fee schedules in billing system to reflect new reimbursement rate of $1,214.63 for HCPCS code J7307 (etonogestrel contraceptive implant) for Connecticut Medicaid patients. FQHCs should verify they are using family planning clinic fee schedule rates, and hospitals should confirm they are following CMAP Addendum B guidelines for payment determination.

Affected Billing Codes

J7307