MedicaidCoverageHigh impact
Spinal Fusion and Stabilization Surgery - MEDICAID - MICHIGAN (Revised)
Humana·MI · Neurosurgery, Orthopedics, Pain Management·Medicaid
Effective date
Apr 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Michigan Medicaid has updated their spinal fusion and stabilization surgery policy with revised coverage criteria for corpectomy, kyphectomy, lumbar disc replacement, and sacroiliac joint fusion procedures. The policy includes specific eligibility requirements and contraindications for each procedure type.
Action Required
Before April 1, 2025: Billing and authorization teams must update prior authorization protocols for spinal fusion procedures to align with new Humana Michigan Medicaid criteria. Update system to verify specific eligibility requirements for corpectomy (nerve compression evidence), kyphectomy (functional limitations or deformity progression), and lumbar disc replacement (single level L3-S1 only). Ensure documentation includes required diagnostic imaging and conservative treatment failure evidence. Claims without meeting new criteria will be denied.