MedicaidBilling CodesMedium impact
Hospital Monthly Important Message Updated as of 04/11/2018 pdf
Connecticut Medicaid (HUSKY Health)·CT · Physical Therapy, Occupational Therapy, Oncology +1 more·Provider Bulletin
Effective date
Apr 1, 2018
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (CMAP) updated multiple billing procedures including new procedure codes for therapy services (97763, 97127, G0515), HCPCS unit changes for drug codes, and new prior authorization requirements for specialty drugs Kymriah and Luxturna. The policy also addresses ongoing outpatient therapy claims reimbursement issues and reminds providers that billing clients for missed appointments is prohibited.
Action Required
Immediately: Update billing systems to include new therapy codes 97763, 97127, and G0515 under appropriate revenue center codes. Update HCPCS drug code units for J-codes as specified (effective retroactive to January 1, 2018). For Kymriah and Luxturna, obtain prior authorization by faxing completed PA forms to CHNCT at (203) 265-3994 using procedure codes Q2040 and C9399 respectively. Review EOB code explanations for new codes 0326, 0878, 7501, and 7502. Monitor for system adjustments on outpatient therapy claims that may be reprocessed.