MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - MICHIGAN (New)
Humana·MI · Cardiology, Cardiothoracic Surgery, Internal Medicine +2 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New Humana Medicaid policy for cardiac devices in Michigan establishes specific coverage criteria for automated external defibrillators, implantable cardioverter-defibrillators, and mobile cardiac outpatient telemetry. The policy defines strict medical necessity requirements and eligible billing codes for each device type.
Action Required
Before January 1, 2026: Billing team must update prior authorization processes for cardiac device claims to verify patients meet specific medical necessity criteria outlined in policy HUM-2011-000. Update billing system to flag AED (E0617), ICD components (C1721, C1722, C1777, C1882, C1895, C1899), and MCOT services (93228, 93229) for Michigan Medicaid patients. Train staff on new coverage limitations - AEDs only covered when ICD contraindicated and specific cardiac conditions present, MCOT only for infrequent symptoms less than every 48 hours.