MedicaidCoverageHigh impact
Orthotics - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +3 more·Medicaid
Effective date
Jun 3, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new comprehensive orthotics coverage policy for South Carolina Medicaid members, defining coverage criteria for various orthotic devices including braces, splints, supports, and specialty items. The policy provides specific HCPCS codes and medical necessity requirements for lower extremity, foot, and spine orthotics.
Action Required
Before June 3, 2025: Billing team must update systems with new Humana South Carolina Medicaid orthotics coverage criteria for all listed HCPCS codes. Providers must ensure detailed clinical documentation including medical necessity justification, goniometer measurements for AFO contracture treatments, and specific condition requirements are documented in medical records. Update encounter forms to include required documentation elements. Claims without proper documentation will be denied.