MedicaidCoverageMedium impact
Breast Procedures - MEDICAID - OKLAHOMA (Revised)
Humana·OK · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
Jan 9, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated their Oklahoma Medicaid breast procedures policy effective January 9, 2026, defining comprehensive coverage criteria for breast reconstruction, implant removal, and reduction mammaplasty following mastectomy, lumpectomy, or trauma. The policy specifies covered and non-covered scenarios with detailed CPT codes for billing teams.
Action Required
Before January 9, 2026: Billing team must update system rules for Oklahoma Medicaid breast procedure claims to ensure proper coverage determination criteria are met before submission. Update encounter forms to include trauma timeframe documentation (within 12 months) and Baker grade classification for capsular contracture. Train staff on new liposuction-only reduction mammaplasty exclusion - these claims will be denied.