MedicaidCoverageMedium impact
Prosthetics - MEDICAID - KENTUCKY (New)
Humana·KY · Orthopedics, Plastic Surgery, PM&R (Physical Medicine & Rehab) +3 more·Medicaid
Effective date
Oct 7, 2025
We identified it
Jun 24, 2026
Summary
New Humana Medicaid policy for Kentucky establishes comprehensive coverage criteria for prosthetic devices including limbs, eyes, ears, and specialized systems. The policy defines covered prosthetics, specific eligibility requirements, and billing codes for various prosthetic components and services.
Action Required
Before October 7, 2025: Billing team must review and implement new Humana Kentucky Medicaid prosthetics coverage criteria. Update prior authorization workflows for OPRA devices (L5991) to verify age 22-65 and specific medical criteria. Ensure documentation captures medical necessity for all prosthetic claims to restore ADL function. Train staff on new socket quantity limits (up to 2 test sockets and 2 regular sockets per prosthesis).