MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Cardiology, Cardiothoracic Surgery, Emergency Medicine +1 more·Medicaid
Effective date
Jul 8, 2025
We identified it
Jun 24, 2026
Summary
Humana has revised their South Carolina Medicaid policy for cardiac devices, updating coverage criteria for automated external defibrillators (AEDs), implantable cardioverter-defibrillators (ICDs), and mobile cardiac outpatient telemetry (MCOT). The policy includes specific eligibility requirements and exclusions for each device type.
Action Required
By July 8, 2025: Billing team must update prior authorization requirements for South Carolina Medicaid cardiac device claims. Ensure documentation includes specific criteria outlined in policy for AEDs (E0617), ICD components (C-codes), and MCOT services (93228, 93229). Verify patient eligibility meets exact clinical conditions and exclusion criteria before submitting claims to prevent denials.