MedicaidCoverageMedium impact
Cosmetic and Reconstructive Surgery - MEDICAID - KENTUCKY (New)
Humana·KY · Plastic Surgery, Dermatology, General Surgery·Medicaid
Effective date
Mar 26, 2025
We identified it
Jun 24, 2026
Summary
New Humana Medicaid policy for Kentucky establishes specific coverage criteria for cosmetic and reconstructive surgery procedures. The policy defines when procedures like scar revision, vaginoplasty, and cutaneous vascular lesion removal are medically necessary versus cosmetic, with most cosmetic procedures excluded from coverage.
Action Required
Before March 26, 2025: Review all pending cosmetic and reconstructive surgery claims for Kentucky Humana Medicaid members. Update prior authorization workflows to verify functional impairment documentation is present for covered procedures like scar revision, vaginoplasty, and cutaneous vascular lesion removal. Train staff on new coverage criteria requiring objective functional impairment for most reconstructive procedures. Flag all cosmetic procedures as non-covered unless they meet specific exceptions outlined in policy.