MedicaidPrior AuthMedium impact
Guidance for Cystic Fibrosis & Spinal Muscular Atrophy Testing pdf
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is expanding prior authorization exemptions for Cystic Fibrosis and Spinal Muscular Atrophy genetic testing, adding new diagnosis codes that allow testing without prior auth for procreative management encounters.
Action Required
By January 1, 2021: Billing team must update system to recognize that Z31.430 and Z31.440 diagnosis codes override prior authorization requirements for CF testing (CPT 81220-81224) and refer to new Table 11A for SMA testing (CPT 81329) exemptions. Download updated Fee Schedule Instructions from www.ctdssmap.com to access complete diagnosis code lists.