MedicaidCoverageMedium impact
Breast Reconstruction - MEDICAID - KENTUCKY (New)
Humana·KY · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
Mar 26, 2025
We identified it
Jun 24, 2026
Summary
This is a new Humana Medicaid policy for Kentucky covering breast reconstruction procedures following mastectomy, lumpectomy, prophylactic mastectomy, or trauma. The policy establishes coverage criteria for various reconstruction techniques including implants, tissue flaps, and corrective procedures, with specific requirements for autologous fat grafts requiring medical director review.
Action Required
Before March 26, 2025: Billing team must review all breast reconstruction claims for Humana Medicaid Kentucky members to ensure they meet the new coverage criteria. Flag all autologous fat graft procedures as stand-alone treatments for medical director review before submission. Update prior authorization workflows to include trauma timeframe verification (within 12 months post-injury) and medical necessity documentation for asymmetry corrections.