MedicaidPrior AuthHigh impact
Hospital Monthly Important Message - 12.17.2024
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Nov 15, 2024
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (CMAP) has updated multiple systems including HCPCS coding changes effective October 1, 2024, new prior authorization requirements for specific J-codes effective November 15, 2024, and upcoming DRG grouper changes effective January 1, 2025. The policy also requires valid Type 2 diabetes diagnosis codes for GLP-1 agonist medications effective December 15, 2024.
Action Required
Immediately: Update billing system to require prior authorization for J-codes J0172, J0174, J0224, J1413, J1426, J1427, J1429, J3241, and J7330 for dates of service November 15, 2024 and forward. By December 15, 2024: Ensure valid Type 2 diabetes ICD-10 diagnosis codes are included for all GLP-1 agonist medications (Trulicity, Byetta, Bydureon, Rybelsus, Victoza/liraglutide, Ozempic, Mounjaro). By January 1, 2025: Prepare for updated DRG weights and outlier thresholds. Failure to obtain prior auth will result in claim denials.