L0970 Insurance Policy Changes

Orthotics - MEDICAID - SOUTH CAROLINA (Revised)

Humana SC Medicaid has issued a revised orthotics coverage policy (HUM-SC-2177-001) effective 09/23/2026 that establishes medical necessity criteria for braces, splints, casts, and orthopedic devices across lower extremity, foot, and spine categories. The policy specifies which HCPCS codes are covered and requires detailed clinical documentation and physician prescriptions for approval. Billing teams must ensure claims include proper medical justification aligned with the specific clinical criteria outlined for each orthotic type.