MedicaidCoverageMedium impact
Skin and Tissue Substitutes - MEDICAID - KENTUCKY (New)
Humana·KY · Wound Care, Plastic Surgery, General Surgery +2 more·Medicaid
Effective date
Oct 7, 2025
We identified it
Jun 24, 2026
Summary
New Kentucky Medicaid policy establishes coverage criteria for 13 specific skin and tissue substitute products for wound care, burns, and breast reconstruction. The policy defines which HCPCS codes are covered and under what clinical conditions each product can be billed.
Action Required
Before October 7, 2025: Billing team must update Kentucky Medicaid billing rules to include coverage criteria for skin and tissue substitute HCPCS codes Q4100-Q4186. Verify clinical documentation meets specific wound type, duration (>4 weeks), and anatomical criteria for each product before billing. Claims will be denied if coverage criteria are not met.