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Spinal Decompression Surgery - MEDICAID - MICHIGAN (New)
Act
by Jul 22, 2026
Effective date
Jul 22, 2026
Identified
Jul 23, 2026
Summary
Humana Medicaid Michigan has released a new spinal decompression surgery coverage policy (effective 07/22/2026) that establishes specific clinical criteria for coverage of discectomy, laminectomy, foraminectomy, and related procedures. The policy requires documented medical necessity including imaging confirmation, failed conservative treatment (typically 6 weeks), and specific clinical/neurological findings. Billing teams must verify these criteria are met before submitting claims to avoid denials.
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What to do
by Jul 22, 2026 · 7 steps
01Billing team must implement pre-claim verification process for all spinal decompression procedures billed to Humana Medicaid Michigan (Policy HUM-MI-2660-000).
02Update billing system to flag CPT codes 63055, 63064, 63066, 63077, 63078, 63172, 63173, 63295, 63185, 63190, 22100, 22103 for Michigan Medicaid claims.
03Create internal checklist requiring documentation of: imaging confirmation (MRI/CT), failed conservative treatment period (6 weeks minimum for appropriate diagnoses), corresponding clinical symptoms, and objective neurological findings before claim submission.
04Provider team must attach supporting documentation (operative reports, imaging results, clinical notes) demonstrating medical necessity criteria per policy.
05Train front-desk and clinical staff to obtain and verify these elements during pre-authorization process.
06Failure to meet documented criteria will result in claim denials.
07Contact Humana for prior authorization guidance if criteria ambiguity exists.
Codes mentioned
630556306463066630776307863172631736329563185631902210022103
Original notice
Spinal Decompression Surgery - MEDICAID - MICHIGAN (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 - INDIANA (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