MedicaidCoverageHigh impact
Spinal Decompression Surgery - MEDICAID - INDIANA (New)
Humana·IN · Neurosurgery, Orthopedics, Pain Management·Medicaid
We identified it
Jul 23, 2026
Summary
Humana Medicaid Indiana has issued a new policy defining spinal decompression surgery as a covered procedure encompassing multiple surgical techniques (discectomy, laminectomy, laminotomy, foraminotomy, foraminectomy, facetectomy, spinal fusion, and combinations thereof) to relieve spinal cord and nerve root compression. The billing team must identify which specific CPT codes map to these procedures and implement any associated billing rules or prior authorization requirements for Indiana Medicaid claims.
Action Required
IMMEDIATE PRIORITY - Billing team must: (1) Contact Humana directly or access the full policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a57efd7 to obtain the complete policy including effective date, specific CPT codes covered, prior authorization requirements, and medical necessity criteria; (2) Once full policy details are obtained, update billing software to ensure correct coding and documentation for spinal decompression procedures (discectomy, laminectomy, laminotomy, foraminotomy, foraminectomy, facetectomy, spinal fusion); (3) Determine if prior authorization is required before submitting claims; (4) Update provider encounter forms and billing templates to reflect coverage confirmation; (5) Train billing and clinical staff on Indiana Medicaid-specific requirements for these procedures. Without complete policy details, claims may be denied or improperly coded. This summary-only format is insufficient for operational implementation.