MedicaidPrior AuthMedium impact
Xeomin® (incobotulinumtoxinA) (Revised)
Humana·KY · Neurology, PM&R (Physical Medicine & Rehab), Pain Management +3 more·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana has revised its Xeomin (incobotulinumtoxinA) prior authorization policy for Kentucky Medicaid and Medicare effective January 1, 2024, with updates as of June 24, 2026. The policy clarifies four covered medical indications (blepharospasm, cervical dystonia, chronic sialorrhea, and upper limb spasticity in adults and select pediatric patients) while maintaining explicit exclusions for cosmetic uses and non-approved conditions. Prior authorization is required for all Xeomin claims under this policy.
Action Required
By June 24, 2026 (policy revision date): Billing team must ensure all Xeomin (incobotulinumtoxinA) claims for Kentucky Medicaid and Medicare members are routed through prior authorization workflow. Verify requested indication matches one of four approved uses: blepharospasm (age 18+), cervical dystonia (age 18+), chronic sialorrhea (age 2+), or upper limb spasticity (age 18+ adults, or age 2-17 pediatrics excluding cerebral palsy). Reject or deny claims for excluded indications listed in policy (migraine, TMD, low back pain, gastroparesis, cosmetic purposes, pediatric cerebral palsy spasticity, and all experimental/investigational uses). Update prior authorization submission templates to confirm medical necessity documentation aligns with CMS-recognized compendia or peer-reviewed literature. Train billing and clinical staff that claims submitted without prior authorization or for non-covered indications will be denied. Verify provider claim codes via www.humana.com/PAL for current coding requirements.