Spinal Decompression Surgery - MEDICAID - SOUTH CAROLINA (Revised)
Summary
Humana's Medicaid coverage policy for spinal decompression surgery in South Carolina sets the criteria under which members may be eligible for discectomy, including microdiscectomy and minimally invasive approaches, such as confirmed myelopathy with corresponding clinical symptoms and objective neurological signs, or a herniated disc with radicular pain that has persisted for 6 weeks despite conservative treatment. It also sets criteria for laminectomy with drainage of intramedullary cyst/syrinx (63173), laminectomy with rhizotomy (63190), and sacral and thoracic laminectomy and foraminotomy procedures. For members under age 21, requests are reviewed for medical necessity under EPSDT requirements.
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