HCPCS/CPT coding requirements payment policy updated, effective Jan. 1, 2021


We have updated our Payment Policy: HCPCS and CPT Coding Requirements for Outpatient Claims for commercial plans. The updated policy goes into effect Jan. 1, 2021. It applies only to ConnectiCare members with commercial plans.


Health Care Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes are required on outpatient claims. The policy includes a list of revenue codes that require a HCPCS/CPT procedure code(s) when billed on outpatient claims, UB04. Outpatient claims for services that are billed without the required HCPCS and/or CPT code(s) will not be paid and will be returned to providers for proper resubmission.