MedicaidCoverageMedium impact
Breast Procedures - MEDICAID - INDIANA (New)
Humana·IN · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
This is a new Humana Medicaid policy for Indiana establishing coverage criteria for breast reconstruction procedures, implant removal, and related surgeries. The policy defines specific medical necessity requirements and covered scenarios for breast procedures under Indiana Medicaid.
Action Required
By January 1, 2025: Billing team must update systems to reflect Humana Indiana Medicaid coverage criteria for breast procedures. Ensure prior authorization processes align with new medical necessity requirements including trauma within 12 months, medically necessary mastectomy/lumpectomy, and specific complications like Baker grade III/IV capsular contracture. Update encounter forms to capture required documentation for covered indications. Claims not meeting these criteria will be denied.