MedicaidPrior AuthMedium impact
Botox® (onabotulinumtoxinA) (Revised)
Humana·SC · Neurology, PM&R (Physical Medicine & Rehab), Pain Management +4 more·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana South Carolina Medicaid has revised their Botox (onabotulinumtoxinA) prior authorization policy effective July 1, 2024. The policy expands covered indications to include numerous neurological and spastic conditions but requires prior authorization for all uses and excludes cosmetic applications.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Botox injections for South Carolina Medicaid patients before administration. Update encounter forms to include indication documentation requirements. Verify patient age requirements (12+ for blepharospasm, 16+ for cervical dystonia) and document previous treatment failures with alternative medications when required. Claims will be denied without proper prior authorization.