MedicaidPrior AuthHigh impact
Viscosupplements (Revised)
Humana·LA · Orthopedics, Rheumatology, Sports Medicine +1 more·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicaid (Louisiana) has implemented a revised prior authorization policy for viscosupplements effective January 1, 2024, with a recent revision date of March 1, 2026. Coverage is now limited to knee osteoarthritis only, requires documented failure of two specific first-line products (Durolane, Euflexxa, Gelsyn-3, or Supartz FX) before approving alternative viscosupplement products, and mandates a 6-month interval between treatment cycles. All viscosupplement injections require prior authorization before administration.
Action Required
Before January 1, 2024 (or immediately for all current requests): Billing team and clinical staff must implement prior authorization workflow for all viscosupplement injections. Update billing system to: (1) Block all viscosupplement claims without prior authorization approval; (2) Flag requests that do not meet Criteria #1 (knee osteoarthritis only - reject requests for other joints); (3) Enforce Criteria #2 requiring documented failure/contraindication/intolerance of TWO first-line products (Durolane, Euflexxa, Gelsyn-3, Supartz FX) before approving alternative products; (4) Verify 6-month interval since last treatment cycle for re-treatment requests (Criteria #3). Providers must document on authorization requests: symptomatic knee OA diagnosis, which two first-line products were previously tried and why they failed/caused adverse effects, and date of last viscosupplement cycle. Front desk staff must obtain prior authorization from Humana before scheduling injections. All claims submitted without prior authorization or failing to meet these three criteria will be denied. Reference Humana's PAL system at www.humana.com/PAL for medical coding requirements.