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MedicaidReimbursementMedium impact

2024.49 - Provider Bulletin - COVID-19 Laboratory Testing Updates to Independent Laboratory Fee Schedule

Connecticut Medicaid (HUSKY Health)·CT · Family Medicine, Internal Medicine, Pediatrics +1 more·Reimbursement
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid (CMAP) is reducing COVID-19 laboratory test reimbursement from 100% to 70% of Medicare rates and discontinuing coverage for specific COVID-19 PLA codes, requiring providers to use standard CPT codes instead. This affects all COVID-19 testing billing for Connecticut Medicaid patients.

Action Required

Action needed
Immediately: Billing team must update fee schedules for COVID-19 lab tests to reflect new 70% Medicare rates. Stop billing PLA codes 0202U, 0223U, 0224U, 0225U, 0226U, 0240U, and 0241U for Connecticut Medicaid patients - replace with equivalent Category I CPT codes from 80000 series. Update billing software with new rates and code restrictions to prevent claim denials.

Affected Billing Codes

87426
87428
87635
87636
87637
87811
86328
86408
86409
87913
86413
86769
U0001
U0002