MedicaidCoverageMedium impact
Spinal Decompression Surgery - MEDICAID - VIRGINIA (New)
Humana·VA · Neurosurgery, Orthopedics, Pain Management·Medicaid
We identified it
Jul 23, 2026
Summary
Virginia Medicaid has issued a new policy defining spinal decompression surgery as a covered service encompassing multiple procedural approaches (discectomy, laminectomy, laminotomy, foraminotomy, foraminectomy, facetectomy, spinal fusion, or combinations thereof) to relieve spinal cord and nerve root compression. Billing teams must verify this policy applies to their patient population and understand the specific procedures covered under this umbrella definition.
Action Required
Immediately: Billing team must obtain the full policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584359) to determine: (1) Effective date of this policy, (2) Specific CPT codes covered under spinal decompression, (3) Prior authorization requirements, (4) Medical necessity criteria, and (5) Any exclusions or limitations. Update internal policy references and provider notices accordingly. Do not bill spinal decompression procedures under Virginia Medicaid until full policy details are reviewed and integrated into billing workflows. Flag any conflicting guidance from previous policies.