MedicaidCoverageMedium impact
Prosthetics - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Orthopedics, Plastic Surgery, Ophthalmology +2 more·Medicaid
Effective date
Feb 11, 2026
We identified it
Jun 24, 2026
Summary
Humana has issued a comprehensive revised policy for prosthetics coverage under South Carolina Medicaid, effective February 11, 2026. This policy establishes detailed coverage criteria for various prosthetic devices including upper and lower limb prostheses, osseointegrated devices, artificial corneas, and facial prostheses with specific eligibility requirements and contraindications.
Action Required
Before February 11, 2026: Billing teams must update prosthetics authorization procedures for South Carolina Medicaid patients to align with new coverage criteria. Review patient eligibility against specific requirements for osseointegrated prostheses (age 22-65, weight under 220 lbs, specific contraindications). Update prior authorization requests to include required documentation for medical necessity and functional level assessments. Train staff on new device categories and coverage limitations to ensure proper claim submission.