Connecticut medicaid fee schedule

Outpatient Hospital Rates

July 1, 2016 - DSS issued outpatient rates effective for dates of service on and after July 1, 2016 using the Ambulatory Payment Classification (APC).
In-State Hospital APC Rate Letters
Out-of-State Hospital APC Rate Letter

Inpatient Hospital Rates

January 1, 2015 - DSS issued inpatient rates on December 8, 2014 for admissions on or after January 1, 2015. The letters list the APR-DRG base rates as well as per diem rates for behavioral health and rehabilitation.
In-State Inpatient Hospital Rate Letters
Out-of State and Border Psychiatric Hospital Rate Letter
Out-of-State General Acute Care Hospital Rate Letter
Rate Calculations

DRG Payment Calculator All general acute care hospitals, including border and out-of-state, are now reimbursed using the All Patient Refined Diagnosis Related Groups (APR-DRG) methodology. A hospital can estimate its payment for a claim using the DRG payment calculator. The calculator contains detailed instructions regarding the data to be entered, including a link to 3M's site that must be used to calculate the DRG assignment to be entered in the calculator.

Disproportionate Share Hospital (DSH), Supplemental, and Direct Graduate Medical Education (GME) Payments

Organ Acquisition Reimbursement
Rates are for both in- and out-of-state hospitals . Organ acquisition rates are effective for all inpatient claims. Acquisition of the heart, liver, and kidneys will be manually priced based on the submission of RCC 81X. For lung and pancreas acquisition, hospitals must submit most recent Medicare cost reports submitted to CMS. Additional information can be found on Provider Bulletin 2014-79.

Payment will be the lower of charges or state-wide average.
*For lung or pancreas acquisition, hospitals must submit most recent Medicare cost report submitted to CMS.

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