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Spine Surgery - MEDICAID - OKLAHOMA (New)
Effective date
Jan 7, 2026
Identified
Jun 24, 2026
Summary
New Medicaid spine surgery policy for Oklahoma establishes coverage criteria for artificial disc replacement, minimally invasive sacroiliac joint fusion, spinal fusion, and vertebral body tethering procedures. The policy details specific requirements including age limits, conservative treatment failures, and contraindications that must be met for coverage approval.
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What to do
Action · 3 steps
01Before January 7, 2026: Billing team must update prior authorization processes for Oklahoma Medicaid spine surgery cases to ensure all coverage criteria are met, including 6-month conservative treatment documentation, age verification for disc replacement (60 years or younger), psychological evaluations, and specific contraindication screening.
02Update encounter forms to capture required elements and train providers on documentation requirements.
03Claims not meeting these criteria will be denied.
Codes mentioned
27279
Original notice
Spine Surgery - MEDICAID - OKLAHOMA (New)
mcp.humana.com · Always check the source before changing claims.