MedicaidBilling CodesMedium impact
Hospital Monthly Important Message - 11.12.2019 pdf
Connecticut Medicaid (HUSKY Health)·CT · Psychiatry, Pediatrics·Provider Bulletin
Effective date
Nov 12, 2019
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid updated their outpatient autism billing requirements to require specific CPT/HCPCS codes with Revenue Code Center (RCC) 919, and prior authorization from Beacon Health Options. The system also implemented new APR-DRG V37 grouper processing effective November 12, 2019.
Action Required
Immediately: For Connecticut Medicaid autism services, billing team must use RCC 919 with specified CPT/HCPCS codes (97158, H0031, H0032, H0032 with modifier TS, H0046, H2014, 90791 with modifier U5). Obtain prior authorization from Beacon Health Options under hospital's NPI and AVRS ID before billing. Update billing system to require these specific code combinations for autism claims.