MedicaidCoverageMedium impact
Neurostimulators - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · Neurology, Neurosurgery·Medicaid
Effective date
Jun 17, 2026
We identified it
Jun 24, 2026
Summary
New Medicaid policy for South Carolina establishes coverage criteria for neurostimulator procedures, including skull-mounted cranial neurostimulators for drug-resistant epilepsy. The policy defines specific medical necessity requirements and covers implantation, removal, and replacement procedures.
Action Required
Before June 17, 2026: Billing team must update prior authorization requirements for neurostimulator procedures (CPT 61863, 61867, 61889, 61891, 61892) for South Carolina Medicaid members. Providers must document all coverage criteria including patient age 18+, 3+ disabling seizures per month, refractory to 2+ antiepileptic medications, and contraindication screening. Update encounter forms and EMR templates to capture required documentation elements.