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New Coverage Guidelines - Peristeen Anal Irrigation System pdf

Connecticut Medicaid (HUSKY Health)·CT · Gastroenterology, General Surgery, Urology·Provider Bulletin
Effective date
Aug 1, 2019
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid has established new coverage guidelines for the Peristeen Anal Irrigation System, effective August 1, 2019. All requests require prior authorization using the standard Outpatient Prior Authorization Request Form with clinical documentation supporting medical necessity.

Action Required

Action needed
For Connecticut Medicaid patients needing Peristeen Anal Irrigation System: Billing team must ensure providers submit Outpatient Prior Authorization Request Form with clinical documentation before ordering. Contact CHNCT at 1-800-440-5071 for PA questions. Claims without prior authorization will be denied.

Affected Billing Codes

A6549