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HumanaMedicaid · Coverage · Medicaid · SC · Orthopedics, Neurosurgery, Pain ManagementMedium impact

Spinal Fusion and Stabilization Surgery - MEDICAID - SOUTH CAROLINA (Revised)

Effective date
Jun 17, 2026
Identified
Jun 24, 2026

Summary

Humana has updated their South Carolina Medicaid policy for spinal fusion and stabilization surgery, effective June 17, 2026. The policy provides detailed coverage criteria for corpectomy, kyphectomy, lumbar artificial disc replacement, and sacroiliac joint fusion procedures with specific eligibility requirements.

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What to do

Action · 4 steps
01Before June 17, 2026: Billing team must review and update prior authorization processes for South Carolina Medicaid spinal procedures.
02Ensure documentation meets specific criteria outlined in policy HUM-SC-2235-001 for corpectomy (CPT 63081-63307), kyphectomy (CPT 22818-22819), and lumbar disc replacement (CPT 22857, 22860) procedures.
03Update encounter forms to capture required diagnostic imaging and clinical criteria.
04Claims may be denied without proper documentation of eligibility criteria.

Codes mentioned

630816308563087630906310163102633006330163302633036330463305633066330722818228192285722860

Original notice

Spinal Fusion and Stabilization Surgery - MEDICAID - SOUTH CAROLINA (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Spinal Fusion and Stabilization Surgery - MEDICAID - FLORIDA (New)HighEffective Sep 16, 2026 · MedicaidSpinal Fusion and Stabilization Surgery - MEDICAID - KENTUCKY (New)MediumEffective Aug 5, 2026 · MedicaidSpinal Fusion and Stabilization Surgery - MEDICAID - MICHIGAN (Revised)HighEffective Apr 1, 2025 · MedicaidSpinal Fusion and Stabilization Surgery - MEDICAID - INDIANA (New)HighEffective Jun 17, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesSC policy changesOrthopedicsNeurosurgeryPain ManagementCode 63081Code 63085Code 63087Code 63090Code 63101Code 63102Code 63300Code 63301Code 63302Code 63303Code 63304Code 63305Code 63306Code 63307Code 22818Code 22819Code 22857Code 22860

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