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HumanaMedicare Advantage · Coverage · Pharmacy · Pain Management, Neurology, Neurosurgery +2 moreMedium impact

Implantable Infusion Pumps for Pain or Spasticity - Medicare Advantage (Revised)

Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 24, 2026

Summary

Humana Medicare Advantage has revised their policy for implantable infusion pumps used for pain or spasticity management, establishing specific medical necessity criteria including temporary trial requirements and success metrics. The policy provides detailed coverage determination guidelines for both antispasmodic drugs for severe spasticity and drugs for severe intractable pain treatment.

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What to do

by Jul 1, 2025 · 3 steps
01Billing team must update prior authorization requirements for implantable infusion pump procedures to include documented temporary trial results, baseline Ashworth scores of at least 3 for spasticity cases, and evidence of 6-week failed conservative treatment.
02Providers must document FDA-approved drug usage and absence of contraindications.
03Update encounter forms to capture required medical necessity criteria as claims may be denied without proper documentation.

Codes mentioned

623226232362324623256232662327C2626623606236162362C1772C1891E0782E0783

Original notice

Implantable Infusion Pumps for Pain or Spasticity - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Implantable and External Infusion Pumps for Pain or Spasticity - Medicare Advantage (Revised)MediumEffective Jul 1, 2026 · PharmacyInjections for Chronic Pain Conditions - MEDICAID - OKLAHOMA (Revised)HighEffective Jul 29, 2026 · MedicaidInjections for Chronic Pain Conditions - MEDICAID - KENTUCKY (Revised)HighEffective Jul 15, 2026 · MedicaidInjections for Chronic Pain Conditions - MEDICAID - OKLAHOMA (New)HighEffective Jan 7, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesPain ManagementNeurologyNeurosurgeryAnesthesiologyPM&R (Physical Medicine & Rehab)Code 62322Code 62323Code 62324Code 62325Code 62326Code 62327Code C2626Code 62360Code 62361Code 62362Code C1772Code C1891Code E0782Code E0783

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