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Spinal Decompression Surgery - MEDICAID - INDIANA (New)
Act
by Jul 22, 2026
Effective date
Jul 22, 2026
Identified
Jul 23, 2026
Summary
Humana Indiana Medicaid released new coverage criteria for spinal decompression surgery effective 07/22/2026. This policy establishes specific medical necessity requirements for discectomy, laminectomy, foraminectomy, and related procedures, including diagnostic imaging confirmation and conservative treatment trials (6 weeks minimum for radicular pain). Billing teams must verify patient eligibility against these criteria before submitting claims to avoid denials.
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What to do
by Jul 22, 2026 · 6 steps
01Billing team must update authorization and claims submission workflows for Humana Indiana Medicaid spinal decompression procedures.
02Implement pre-authorization review requirements: verify diagnostic imaging documentation (MRI/CT confirming compression), confirm appropriate clinical symptoms (myelopathy signs, radicular pain, neurological deficits), and validate 6-week conservative treatment trial for radicular pain cases (epidural injections, NSAIDs, PT) before submitting claims for CPT 63055, 63064, 63066, 63077, 63078, 63172, 63173, 63295, 63185, 63190, 22100, 22103.
03Providers must document in medical records: specific diagnostic imaging findings, corresponding clinical symptoms, and conservative treatment attempts with dates.
04Billing software administrators must create claim edit rules to flag missing documentation and require attachment of imaging reports, clinical notes, and conservative treatment records.
05Front desk staff should update patient intake forms to ask about prior PT or injections.
06Claims submitted without evidence of meeting medical necessity criteria will be denied by Humana Indiana Medicaid.
Codes mentioned
630556306463066630776307863172631736329563185631902210022103
Original notice
Spinal Decompression Surgery - MEDICAID - INDIANA (New)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Spinal Decompression Surgery - MEDICAID - FLORIDA (New)HighEffective Sep 16, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - MICHIGAN (New)HighEffective Jul 22, 2026 · MedicaidSpinal Decompression Surgery - Medicare Advantage (Revised)HighEffective Nov 2, 2026 · Medicare AdvantageSpinal Decompression Surgery - MEDICAID - KENTUCKY (New)HighEffective Oct 7, 2026 · MedicaidBrowse every Humana change in the policy list