MedicaidReimbursementMedium impact
Update to Procedure Codes S5000 and J7304 on the Family Planning Clinic Fee Schedule pdf
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN, Family Medicine·Reimbursement
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid updated reimbursement rates for specific family planning drugs (Fluconazole, Terconazole, and Xulane patch) and changed physician-administered vaccine rates to 100% of Medicare ASP pricing. All claims must include proper NDC codes to avoid denials.
Action Required
Family planning clinics billing Connecticut Medicaid must: 1) Update billing system with new reimbursement rates for S5000 (Fluconazole $10.93, Terconazole $21.39) and J7304 (Xulane $81.75), 2) Ensure all drug claims include corresponding 11-digit NDC codes to prevent denials, 3) Download updated fee schedule from www.ctdssmap.com Provider Fee Schedule section, 4) Update vaccine billing to reflect new Medicare ASP-based rates.