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Injections for Chronic Pain Conditions - MEDICAID - KENTUCKY (Revised)
Effective date
Jul 15, 2026
Identified
Jul 14, 2026
Summary
Humana Kentucky Medicaid has revised its policy on injections for chronic pain conditions (effective 07/15/2026). The policy establishes strict prior authorization requirements, treatment protocols (diagnostic vs. therapeutic phases), imaging guidance mandates, and limits on multiple-level injections per session. Billing teams must implement prior auth workflows and enforce clinical criteria including 4 weeks of conservative treatment, radicular pain confirmation, and specific injection frequency rules.
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What to do
Action · 8 steps
01By 07/15/2026: Billing team must implement prior authorization requirement for all epidural steroid injections (CPT 62321, 62323) for Kentucky Medicaid members.
02Update billing system to require documentation of: (1) 4 consecutive weeks of conservative treatment within past 12 months (activity modification, NSAIDs, physical therapy); (2) radicular pain confirmation with positive straight leg raise or dermatomal sensory loss; (3) imaging guidance (CT or fluoroscopy) confirmation.
03Configure system to enforce limits: caudal/interlaminar = 1 level per session only, transforaminal/SNRB = maximum 2 injections per session (unilateral or bilateral single level).
04Diagnostic phase: maximum 2 injections at 2-week intervals minimum; if <50% pain reduction, deny further treatment.
05Therapeutic phase: enforce minimum 2-month intervals between injections.
06Add prior auth checklist to provider order entry.
07Train front desk and billing staff on new requirements.
08Claims submitted without prior authorization or failing to meet clinical criteria will be denied.
Codes mentioned
6232162323
Original notice
Injections for Chronic Pain Conditions - MEDICAID - KENTUCKY (Revised)
mcp.humana.com · Always check the source before changing claims.
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