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MedicaidReimbursementHigh impact

Update to the Billing Guidance to the HCPCS Codes for Skin Substitutes pdf

Connecticut Medicaid (HUSKY Health)·CT · Wound Care, Plastic Surgery, Dermatology +2 more·Coding
Effective date
Nov 1, 2018
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid now requires providers to bill actual acquisition costs for skin substitute products using 82 specific HCPCS codes (Q4100-Q4182). All claims will suspend for manual pricing review, and original invoices must be retained in patient records for audit purposes.

Action Required

Action needed
By November 1, 2018: Billing team must submit actual acquisition costs (not list prices) when billing Connecticut Medicaid for skin substitute HCPCS codes Q4100-Q4182. Claims will automatically suspend for manual pricing review. Medical records staff must retain original invoices and receipts in patient files for audit purposes. Post-payment adjustments will occur if invoices don't match billed amounts or are unavailable.

Affected Billing Codes

Q4100
Q4103
Q4117
Q4118
Q4122
Q4124
Q4125
Q4126
Q4127
Q4128
Q4130
Q4134
Q4135
Q4136
Q4137
Q4138
Q4139
Q4140
Q4141
Q4142
Q4143
Q4145
Q4146
Q4147
Q4148
Q4149
Q4150
Q4151
Q4152
Q4153
Q4154
Q4155
Q4156
Q4157
Q4158
Q4159
Q4160
Q4161
Q4162
Q4163
Q4164
Q4165
Q4166
Q4167
Q4168
Q4169
Q4170
Q4171
Q4172
Q4173
Q4174
Q4175
Q4176
Q4177
Q4178
Q4179
Q4180
Q4181
Q4182