Last Updated: January 30, 2026
The Connecticut Medicaid fee schedule 2026 shows what providers get paid for HUSKY Health services.
Rates vary by provider type, with most physicians receiving 71% of Medicare rates. Connecticut uses a fee-for-service model, unlike most states.
Quick Summary:
- Hospital rates updated January 1, 2026 with new APR-DRG weights
- Physician services average 71% of Medicare rates statewide
- FQHCs receiving historic $80 million funding increase over three years
- Home health fee schedule updated with new skilled nursing rates
- Download official rates at the ctdssmap.com portal
- Timely filing limit increased to 120 days for all claims
What Is the Connecticut Medicaid Fee Schedule?
Connecticut Medicaid is officially called HUSKY Health. It covers over 1.1 million state residents—about one in three people.
The fee schedule lists how much the state pays providers. Connecticut uses fee-for-service, not managed care. This means providers bill the state directly.
Key Terms to Know
CMAP – Connecticut Medical Assistance Program (official program name)
FMAP – Federal Medical Assistance Percentage (Connecticut gets 50% federal match in 2026)
APR-DRG – All Patient Refined Diagnosis-Related Groups (how hospitals get paid)
FQHC – Federally Qualified Health Centers (community clinics)
Understanding Connecticut Medicaid eligibility 2026 helps you know if you qualify before checking provider rates.
How to Download the 2026 Fee Schedule
You must use the official state portal. Third-party sites often show old rates.
Step-by-Step Access
- Go to www.ctdssmap.com
- Click the “Provider” tab at top
- Select “Provider Fee Schedule Download”
- Read and accept the license agreement
- Choose your provider type from the list
- Download the Excel or PDF file
Available schedules include physician services, dental, behavioral health, hospital rates, and home health.
The portal requires you to accept the copyright terms. This protects CPT and CDT code licensing.
2026 Fee Schedule Updates (Effective January 1)
Several major changes took effect at the start of 2026. These affect billing and reimbursement across multiple provider types.
Hospital Inpatient Services
New APR-DRG weights and base rates apply to all admissions on or after January 1, 2026. Peer-group adjustment factors were updated annually.
Organ acquisition rates increased for 2026:
- Kidney: $91,081 (up from $88,129)
- Heart: $213,969 (up from $208,804)
- Liver: $122,923 (down from $141,723)
Laboratory Services
The lab fee schedule now includes January 2026 HCPCS coding changes. This covers new codes, deleted codes, and updated descriptions.
Home Health Services
Updated rates took effect January 1, 2026. Changes include skilled nursing services and home health aide visits.
Revenue center codes and HCPCS codes now show maximum allowable fees.
Durable Medical Equipment
DME, orthotics, and prosthetics schedules updated for HIPAA compliance. You must use the current 2026 HCPCS codes to avoid denials.
Checking Connecticut Medicaid income limits 2026 helps patients verify coverage before scheduling services.
Physician and Practitioner Rates
Connecticut physician rates average 71% of Medicare payment amounts. This is slightly below the national Medicaid average of 75%.
2026 Reimbursement by Provider Type
| Provider Type | Payment Rate | Notes |
|---|---|---|
| Physicians | 71% of Medicare (average) | Range: 56% to 111% by service |
| Nurse Practitioners | 90% of physician fees | 100% for drugs and CRNA services |
| Physician Assistants | 90% of physician fees | 100% for physician-administered drugs |
| Nurse-Midwives | 100% of physician fees | Full maternity bundle payments |
| Acupuncturists | 100% of physician fees | Schedule set October 2021 |
| Behavioral Health | Fixed fee schedule | LCSW, LMFT, LPC, LADC rates |
Service-Specific Payment Rates
Obstetric care receives the highest rate at 111% of Medicare. Connecticut is one of only six states paying above Medicare for maternity services.
Office visits are paid at 73% of Medicare rates.
Hospital and emergency department visits get only 56% of Medicare. This is among the lowest rates compared to other states.
The 2026 Medicare conversion factor is $33.40 for most providers. To estimate Connecticut Medicaid payment, multiply Medicare RVUs by 0.71, then by $33.40.
FQHC Payment Changes (Historic Increase)
Federally Qualified Health Centers are getting major funding relief in 2026. This reverses years of frozen reimbursement rates.
$80 Million Investment Over Three Years
The state allocated new funding as follows:
- $5 million in fiscal year 2026
- $7 million in fiscal year 2027
- $14 million in fiscal year 2028
Previous FQHC rates averaged just $163.37 per visit. This was the lowest in New England.
Neighboring states pay much more:
- New Hampshire: $297 per visit
- Massachusetts: $241.96 per visit
- Vermont: $196.79 per visit
Annual Rate Increases Required
Starting January 1, 2026, FQHC rates must increase annually. Increases follow the Medicare Economic Index.
This funding aims to restore services cut due to low rates. Many FQHCs eliminated dental and behavioral health programs.
For patients using FQHCs, reviewing the Medicaid fee schedule 2026 across states shows Connecticut’s historic underpayment issue.
Dental Fee Schedule Details
Connecticut dental services run through the Connecticut Dental Health Partnership (CTDHP). Separate schedules exist for adults and children.
Prior Authorization Requirements
Different codes have different approval rules:
PA – Prior authorization required for all ages
PR – Post-procedure review required
PAR – Prior auth for adults over 21, post-review for children under 21
<21 or >21 – Age-specific prior authorization needed
HUSKY B Copayments
HUSKY B members (children in families above Medicaid limits) pay copays. Copays are typically 20% of the fee schedule amount.
Important: Copays are based on the schedule rate, not what providers bill.
Adult dental services are generally reimbursed at 52% of the master fee schedule rates.
Hospital Payment Systems
Connecticut hospitals use two different payment methods. Inpatient and outpatient services have separate rate structures.
Inpatient Services (APR-DRG)
All Patient Refined Diagnosis-Related Groups determine payment. Each admission gets assigned a DRG code based on diagnosis and severity.
New 2026 DRG weights took effect January 1. Peer-group adjustments apply to ensure fair payment across hospital sizes.
Outpatient Services (APC)
Ambulatory Payment Classifications pay for outpatient visits. Annual rate letters are published each January 1.
Pediatric Psychiatric Rates
Special per-diem rates apply through December 31, 2026. Add-on payments include:
- Increasing access tier: $1,292.27 in 2026 (highest tier)
- High acuity add-on: Additional 10% payment
- Discharge delay rate: Full per-diem for medically necessary delays
Families seeking mental health coverage should verify Medicaid income limits by state in 2026 to compare Connecticut benefits with neighboring states.
Important Billing Rules for 2026
Providers must follow updated administrative requirements. Several key deadlines changed for 2026.
Timely Filing Limit Extended
The deadline to submit initial claims is now 120 days. This increased from 60 days for dates of service on or after January 1, 2025.
The extension continues through 2026 and beyond.
HIPAA Compliance Required
All 2026 fee schedules follow updated HIPAA coding standards. This especially affects DME and supply billing.
You must use current January 2026 HCPCS and CPT codes. Using outdated codes causes automatic claim denials.
Electronic Claim Submission
Claims process through Gainwell Technologies (the fiscal agent). Submissions must use HIPAA-compliant formats.
Providers need a Trading Partner Agreement before submitting electronic claims.
Special Payment Programs
Connecticut offers alternative payment models beyond standard fee-for-service. These programs provide enhanced reimbursement.
Maternity Bundle Program
Episode-based case rates started January 1, 2025, and continue through 2026. Bundles cover prenatal care, delivery, and postpartum visits.
Add-on payments include doula support and lactation services. Accountable providers receive monthly case rate payments with year-end reconciliation.
Nurse-midwives qualify for full maternity bundle payments at 100% of physician rates.
Patient-Centered Medical Home (PCMH)
Qualifying primary care practices receive enhanced payments. PCMH rates reward coordinated care and better health outcomes.
Telehealth Services
Connecticut covers telehealth services across multiple specialties. Reimbursement parity varies by service type and location.
Budget and Financial Context
Connecticut faces significant Medicaid budget pressures in 2026. These financial challenges affect future rate decisions.
The state projects an $80 million Medicaid shortfall in fiscal year 2026. By 2030, Medicaid costs are expected to increase by $1.2 billion.
Federal Requirements
CMS requires all states to post fee schedules online by July 1, 2026. Connecticut already meets most compliance requirements through the DSS MAP portal.
Updates must happen monthly with Medicare comparison data.
Work Verification Changes
New federal work requirements take effect January 2027. Beneficiaries will need eligibility checks every six months instead of annually.
Finding Specific 2026 Rates
To look up exact reimbursement for specific procedure codes, follow these steps.
Rate Lookup Process
- Visit ctdssmap.com/ctportal/provider/provider-fee-schedule-download
- Accept the CPT and CDT license agreements
- Select the relevant provider schedule
- Download the CSV or Excel file
- Search for your specific CPT or HCPCS code
Provider Type Selection
Choose the right schedule for your service:
- “Physician” for medical services and procedures
- “Dental” for oral health and orthodontic services
- “Behavioral Health” for mental health and substance use
- “Home Health” for skilled nursing and aide services
- “Hospital” for inpatient and outpatient facility rates
Calculating Expected Payment
For services without fixed rates, use this formula:
Medicare RVUs × 0.71 × $33.40 = Approximate CT Medicaid Payment
This applies to most physician services. Remember that obstetric care uses 111% instead of 71%.
Frequently Asked Questions
What is the Connecticut Medicaid fee schedule for 2026?
The Connecticut Medicaid fee schedule lists what HUSKY Health pays providers for services. Rates vary by provider type. Physicians average 71% of Medicare rates. You download official schedules from ctdssmap.com. Updates took effect January 1, 2026, for hospitals, labs, and home health.
How much do Connecticut Medicaid doctors get paid in 2026?
Connecticut Medicaid pays physicians an average of 71% of Medicare rates in 2026. Office visits receive 73% of Medicare. Obstetric care gets 111% of Medicare—the highest rate. Hospital visits receive only 56% of Medicare. Rates vary by service type and specialty.
Where can I download the 2026 Connecticut Medicaid fee schedule?
Go to www.ctdssmap.com and click “Provider.” Select “Provider Fee Schedule Download.” Accept the license agreement. Choose your provider type (physician, dental, hospital, etc.). Download the Excel or PDF file. Third-party sites often have outdated rates, so use only the official portal.
What changed in the Connecticut Medicaid fee schedule for 2026?
Major changes include new hospital APR-DRG weights effective January 1, 2026. FQHCs received historic $80 million funding over three years. Home health rates updated with new skilled nursing fees. Lab schedules added January 2026 HCPCS codes. Timely filing increased to 120 days for all claims.
How do FQHC rates compare to other provider rates in Connecticut?
FQHCs previously received $163.37 per visit—the lowest in New England. Starting 2026, they receive $5 million in year one of an $80 million increase. Massachusetts pays $241.96 per visit. New Hampshire pays $297. Connecticut rates now increase annually by Medicare Economic Index starting January 2026.
What is the timely filing limit for Connecticut Medicaid in 2026?
The timely filing limit is 120 days for initial claims in 2026. This increased from 60 days for dates of service on or after January 1, 2025. The extension is permanent. Providers must submit claims within 120 days or face denial for untimely filing.
Resources
Official Connecticut Medicaid Portal
Connecticut DSS MAP – Provider Fee Schedule Download
https://www.ctdssmap.com/ctportal/provider/provider-fee-schedule-download
Connecticut Department of Social Services
HUSKY Health Program Information
https://portal.ct.gov/dss/health-and-home-care/medicaid-program-information
This article provides educational information about Connecticut Medicaid fee schedules. Providers should verify all rates through the official DSS MAP portal. Patients should contact HUSKY Health directly for eligibility and enrollment questions.
