MedicaidPrior AuthMedium impact
Prosthetics - MEDICAID - OHIO (New)
Humana·OH · Orthopedics, PM&R (Physical Medicine & Rehab), Plastic Surgery +1 more·Medicaid
Effective date
Jan 7, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prosthetics coverage policy for Ohio Medicaid members, detailing medical necessity criteria and prior authorization requirements for various prosthetic devices including upper/lower limb prostheses, osseointegrated devices, and enhanced dexterity prosthetic arms. The policy requires prior authorization for prosthetics services and establishes specific coverage limitations.
Action Required
By January 7, 2025: Billing team must verify prior authorization requirements for prosthetics services through Humana's Ohio Medicaid Prior Authorization and Notification List. Update workflows to submit medical necessity documentation with all prosthetics prior authorization requests through the provider portal. Claims submitted without required prior authorization may be subject to financial penalties and retrospective review.