Traditional MedicareAdministrativeMedium impact
DSS Important Message - Claim Submission Instructions for Dual Eligible Beneficiaries - 01.28.2022 pdf
Connecticut Medicaid (HUSKY Health)·CT · Pain Management, PM&R (Physical Medicine & Rehab)·Coding
We identified it
Jun 20, 2026
Summary
Acupuncture providers must now submit claims for dual-eligible beneficiaries with chronic low back pain to Medicare first, while acupuncture claims for other conditions can bypass Medicare and go directly to Connecticut Medicaid. Claims will be subject to post-payment audits to ensure primary coverage was exhausted.
Action Required
Immediately: Billing team must update claim submission workflow to identify dual-eligible beneficiaries and route acupuncture claims based on diagnosis - submit chronic low back pain claims to Medicare Part B first, then secondary to Connecticut Medicaid. Submit all other acupuncture claims directly to CMAP. Update billing software rules to reflect Medicare cost-avoidance bypass for non-chronic low back pain acupuncture services.