MedicaidBilling CodesHigh impact
Hospital Monthly Important Message (Updated 8/17/16)
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid implemented multiple billing changes for hospital outpatient services effective July 1, 2016, including new autism spectrum disorder services requiring prior authorization, elimination of certain therapy group RCCs, and mandatory use of G0463 for hospital clinic visits instead of 99211-99245.
Action Required
Immediately for Connecticut Medicaid: 1) Billing team must stop using CPT codes 99211-99245 for hospital clinic services and use G0463 'Hospital outpatient clinic visit' instead with clinic RCCs to avoid denial with EOB code 896. 2) Stop billing RCC 423 (Physical Therapy Group), RCC 433 (Occupational Therapy Group), and RCC 443 (Speech Therapy Group) except for Medicare crossover claims. 3) Obtain prior authorization from Beacon Health Options for all Autism Spectrum Disorder services for members under age 21. 4) By October 1, 2016: Transition all claims to electronic submission as paper claims will no longer be accepted.