MedicaidCoverageMedium impact
Prosthetics - MEDICAID - INDIANA (New)
Humana·IN · Orthopedics, Plastic Surgery, Ophthalmology +2 more·Medicaid
Effective date
May 13, 2026
We identified it
Jun 24, 2026
Summary
Humana has released a new comprehensive Medicaid policy for prosthetics coverage in Indiana, establishing detailed criteria for various prosthetic devices including upper/lower limb prostheses, facial prostheses, and specialized devices like osseointegrated prostheses. This policy defines coverage determination criteria and includes specific billing codes for prosthetic services.
Action Required
Before May 13, 2026: Billing team must review and implement new prosthetics coverage criteria for Indiana Medicaid patients. Update billing system with specific HCPCS codes (L8044, L8609, V2623, V2627, L5961, L5991, L8699, L3250) and CPT codes (21081, 21082, 21084, 21086, 21088) for prosthetic services. Ensure documentation requirements are met for each prosthetic type, particularly age restrictions (22-65 years) and contraindications for OPRA devices. Claims not meeting specified criteria will be denied.