E0912 Insurance Policy Changes

Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - SOUTH CAROLINA (Revised)

Humana updated its South Carolina Medicaid DME/MSEA coverage policy effective 08/26/2026, establishing specific medical necessity criteria for durable medical equipment and clarifying coverage determinations for common items like pediatric walkers, hospital beds, and compression therapy devices. The policy explicitly denies coverage for several items (UpSee Mobility Device, Splashy Bath Seat, Safety Sleep Beds, Snoo Smart Sleep Bassinet, and Flexitouch Plus System) due to insufficient clinical evidence. Billing teams must familiarize themselves with these non-covered items and the reinforced criteria requiring provider documentation, medical necessity substantiation, and cost-effectiveness determinations.