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MedicaidReimbursementMedium impact

2024.45 - Provider Bulletin - April 2024 - Revision of Rates for Certain Clinical Diagnostic Laboratory Testing Codes

Connecticut Medicaid (HUSKY Health)·CT·Reimbursement
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid (HUSKY Health Programs A, B, C, D) reduced reimbursement rates for clinical diagnostic laboratory services effective April 1, 2024, to comply with federal law limiting payments to Medicare rates. One specific code (86409 - COVID neutralizing antibody test) decreased from $105.33 to $79.61.

Action Required

Action needed
Immediately: Billing team should verify the new laboratory fee schedule at www.ctdssmap.com under Provider Fee Schedule Download (Lab section). Review any pending or recent claims for CPT 86409 with dates of service April 1, 2024 and forward - these will be automatically reprocessed at the lower rate ($79.61) in the August 27, 2024 Remittance Advice. Update billing system expectations for Connecticut Medicaid laboratory reimbursements to reflect Medicare rate limitations.

Affected Billing Codes

86409