MedicaidCoverageMedium impact
Spinal Fusion and Stabilization Surgery - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Orthopedics, Neurosurgery, Pain Management·Medicaid
Effective date
Jun 17, 2026
We identified it
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.
Action Required
Before June 17, 2026: Billing team must review and update prior authorization processes for South Carolina Medicaid spinal procedures. Ensure 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. Update encounter forms to capture required diagnostic imaging and clinical criteria. Claims may be denied without proper documentation of eligibility criteria.