MedicaidReimbursementHigh impact
Outpatient Hospital Modernization FAQ
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut has implemented a new Outpatient Prospective Payment System (OPPS) using APC grouper software for Medicaid hospital billing. This affects reimbursement methodology, billing codes, and requires hospitals to follow new payment logic outlined in CMAP Addendum B.
Action Required
Immediately: Connecticut hospitals must transition to APC-based billing system using 3M CMS OCE/APC v17.1 grouper software. Update billing systems to reference CMAP Addendum B for payment determination instead of previous provider bulletins. Use specific RCC codes (421, 424, 431, 434, 441, 444) for therapy services. Bill nutrition, diabetes education, and genetic counseling using G0463. Direct questions to ctxixhosppay@gainwelltechnologies.com. APC logic supersedes all previous communications.