MedicaidPrior AuthMedium impact
Xeomin® (incobotulinumtoxinA) (Revised)
Humana·SC · Neurology, Physical Therapy, PM&R (Physical Medicine & Rehab) +1 more·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its Xeomin (incobotulinumtoxinA) prior authorization policy for South Carolina Medicaid, effective July 1, 2024, with a revision date of June 24, 2026. The policy clarifies four covered indications (blepharospasm, cervical dystonia, chronic sialorrhea, and upper limb spasticity in adults and select pediatric patients) and maintains an extensive exclusion list prohibiting coverage for non-covered indications including migraine, back pain, cosmetic uses, and pediatric cerebral palsy spasticity. Prior authorization remains required for all Xeomin claims under this plan.
Action Required
By July 1, 2024: Billing and clinical teams must implement prior authorization requirements for all Xeomin claims submitted to Humana South Carolina Medicaid. (1) Update billing system to require PA submission before claim processing for Xeomin intramuscular solution. (2) Verify patient age and indication match approved criteria: blepharospasm (18+), cervical dystonia (18+), chronic sialorrhea (2+), upper limb spasticity (18+ adults; 2-17 pediatric excluding cerebral palsy). (3) Train providers to document medical necessity and exclude non-covered indications (migraine, back pain, TMD, cosmetic purposes, pediatric cerebral palsy, etc.). (4) Do NOT submit claims for excluded indications or cosmetic uses; they will be denied. (5) Reference www.humana.com/PAL for current medical billing codes and PA procedures. Failure to obtain prior authorization will result in claim denials.