MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - OHIO (New)
Humana·OH · Cardiology, Cardiothoracic Surgery, Internal Medicine +1 more·Medicaid
Effective date
Dec 3, 2025
We identified it
Jun 24, 2026
Summary
Humana has implemented a new Medicaid policy for cardiac devices in Ohio, establishing specific coverage criteria for automated external defibrillators (AEDs), implantable cardioverter-defibrillators (ICDs), and mobile cardiac outpatient telemetry (MCOT). The policy defines strict medical necessity requirements and lists covered billing codes for these cardiac monitoring and treatment devices.
Action Required
Before December 3, 2025: Billing team must review coverage criteria for cardiac device claims for Ohio Medicaid patients. Ensure documentation meets specific medical necessity requirements including ejection fraction percentages, NYHA classifications, and contraindication criteria before billing codes 93228, 93229, C1721, C1722, C1777, C1882, C1895, C1899, and E0617. Update pre-authorization workflows to verify patient meets eligibility criteria to avoid claim denials.