MedicaidPrior AuthLow impact
Amtagvi (lifileucel) - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Oncology·Medicaid
Effective date
Jul 8, 2025
We identified it
Jun 24, 2026
Summary
New South Carolina Medicaid policy establishes coverage criteria for Amtagvi (lifileucel), an autologous tumor-derived T cell immunotherapy for advanced melanoma. All requests require medical director review through the Corporate Transplant Department.
Action Required
By July 8, 2025: Billing team must route all Amtagvi (lifileucel) requests to Corporate Transplant Department at 1-866-421-5663 or transplant@humana.com for medical director review before billing. Update system to flag HCPCS codes C9399, J3490, J3590 and ICD-10-PCS codes XW033L7, XW043L7 for prior review requirement.