MedicaidPrior AuthMedium impact
Dysport® (abobotulinumtoxinA) (Revised)
Humana·SC · Neurology, PM&R (Physical Medicine & Rehab), Pain Management +1 more·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid in South Carolina has updated their prior authorization policy for Dysport (botulinum toxin) injections, effective July 1, 2024. The policy covers three specific indications: cervical dystonia (age 18+), lower limb spasticity (age 2+), and upper limb spasticity (age 2+), while explicitly excluding cosmetic uses and numerous other conditions.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Dysport injections for South Carolina Medicaid patients. Verify patient meets age requirements (18+ for cervical dystonia, 2+ for spasticity) and has approved diagnoses. Update encounter forms to flag excluded conditions including cosmetic uses, migraines, TMD, and chronic pain. Claims will be denied without proper prior authorization.