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Excessive Skin and Subcutaneous Tissue Removal - MEDICAID - KENTUCKY (New)
Effective date
Jul 22, 2026
Identified
Jul 21, 2026
Summary
Humana Kentucky Medicaid has established new coverage criteria for excessive skin and subcutaneous tissue removal procedures. Coverage now requires: (1) functional impairment from excess skin/tissue, (2) medical complications unrelieved by 12+ weeks of prescribed dermatological therapy, and (3) stable body weight maintained for 6+ months. Prior authorization is mandatory for all applicable procedures. This is a NEW policy effective 07/22/2026.
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What to do
Action · 6 steps
01Billing team must implement mandatory prior authorization requirement for CPT codes 15832, 15834, 15835, 15836, and 15839 in all billing system workflows for Humana Kentucky Medicaid (Healthy Horizons).
02Update encounter forms and provider templates to require documentation of: functional impairment, medical complications, 12+ weeks of failed conservative dermatological treatment, and 6+ months of stable body weight post-weight loss.
03Configure system to reject/hold claims for these codes without prior authorization.
04Train billing staff that cosmetic procedures or requests without meeting all three criteria will be denied.
05Inform plastic surgery providers of new documentation requirements for claim submission.
06Claims submitted without meeting coverage criteria or prior authorization will be denied.
Codes mentioned
1583215834158351583615839
Original notice
Excessive Skin and Subcutaneous Tissue Removal - MEDICAID - KENTUCKY (New)
mcp.humana.com · Always check the source before changing claims.