MedicaidPrior AuthMedium impact
Breast Procedures - MEDICAID - KENTUCKY (Revised)
Humana·KY · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
Jun 24, 2026
We identified it
Jun 24, 2026
Summary
Humana Kentucky Medicaid has revised their breast procedures policy, establishing specific coverage criteria for breast reconstruction, implant removal, and reduction mammaplasty. All listed breast procedure codes now require prior authorization for Kentucky Medicaid members.
Action Required
Before June 24, 2026: Billing team must update prior authorization requirements for all breast procedure codes (19316, 19325, 19328, 19350, 19355, 19371, 19396, C1789, L8600) for Kentucky Medicaid patients. Update billing system to flag these codes and add prior auth reminders to encounter forms. Ensure providers document medical necessity criteria outlined in the policy.