MedicaidCoverageMedium impact
Skin and Tissue Substitutes - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Wound Care, Podiatry, Plastic Surgery +2 more·Medicaid
Effective date
May 25, 2026
We identified it
Jun 24, 2026
Summary
South Carolina Medicaid has established new coverage criteria for skin and tissue substitutes, limiting coverage to diabetic foot ulcers and chronic venous leg ulcers that meet specific duration and wound therapy requirements. All other indications for these products are considered not medically necessary.
Action Required
Before May 25, 2026: Billing team must update prior authorization requirements for all skin and tissue substitute codes (A2001-A2025, Q4101-Q4156) for South Carolina Medicaid patients. Ensure documentation includes wound duration >4 weeks, comprehensive assessment, standard wound therapy compliance, and specific criteria for diabetic foot ulcers or venous leg ulcers. Claims for other indications will be denied as not medically necessary.