MedicaidCoverageHigh impact
Injections for Chronic Pain Conditions - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Pain Management, Anesthesiology, Orthopedics +1 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
This is a new Humana Medicaid policy for South Carolina establishing coverage criteria for chronic pain injection procedures including epidural steroid injections, sacroiliac joint injections, and trigger point injections. The policy requires 4 weeks of conservative treatment failure before injections are covered and limits the number of injection levels per session.
Action Required
By January 1, 2025: Billing team must verify all chronic pain injection claims for Humana Medicaid SC members meet new coverage criteria including 4 weeks of documented conservative treatment failure and radicular pain. Update authorization workflows to limit caudal/interlaminar injections to 1 nerve root level per session and transforaminal injections to maximum 2 per session. Ensure real-time imaging guidance is documented as integral to procedure.