MedicaidCoverageMedium impact
2023.53 Provider Bulletin - Policy Updates and Changes to Clinical Review Criteria pdf
Connecticut Medicaid (HUSKY Health)·CT · Orthopedics, Endocrinology, Neurology +4 more·Provider Bulletin
Effective date
Aug 1, 2023
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (CMAP) has updated clinical review criteria for multiple services including DME rent-to-purchase programs, specialty drugs like Oxlumo and Tepezza, and orthopedic procedures like MACI. Several policies have been retired and will now use InterQual criteria instead.
Action Required
Immediately: Billing team must review updated prior authorization requirements for compression garments (A6549/A4465), specialty drugs (Oxlumo, Tepezza, Spinraza), and MACI procedures for Connecticut Medicaid patients. Access updated policies at https://portal.ct.gov/husky under Medical Management. Contact CHNCT at 1-800-440-5071 for prior authorization questions. Claims may be denied if new criteria are not followed.