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Spinal Decompression Surgery - MEDICAID - VIRGINIA (New)
Effective date
Jul 22, 2026
Identified
Jul 23, 2026
Summary
Humana Medicaid Virginia has released a new comprehensive spinal decompression surgery policy (effective 07/22/2026) establishing specific coverage criteria for discectomy, laminectomy, foraminectomy, and related procedures. The policy requires documented medical necessity including diagnostic imaging confirmation, failed conservative treatment (6 weeks minimum), and specific clinical/neurological findings. Billing teams must verify all authorization requirements before submitting claims for these procedures.
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What to do
Action · 6 steps
01By 07/15/2026: Billing and authorization teams must implement this new Medicaid Virginia spinal decompression policy.
02Update billing software to flag CPT codes 63055, 63064, 63066, 63077, 63078, 63172, 63173, 63295, 63185, and 63190 as requiring prior authorization review for Humana Medicaid VA plans.
03Create authorization checklist requiring: diagnostic imaging confirmation (MRI/CT), documentation of failed conservative treatment duration (minimum 6 weeks), specific clinical symptoms (radicular pain, myelopathy signs, neurological deficits), and clinical justification.
04Train authorization staff on coverage criteria: discectomy requires either myelopathy with neurological signs OR herniated disc with persistent radicular pain after conservative care OR rapidly progressive neurological signs OR spinal fracture/infection/tumor.
05Update provider communications and medical necessity templates to align with policy requirements.
06Configure system to deny claims lacking required documentation and deny procedures not meeting coverage criteria.
If missed: Failure to implement may result in claim denials and member appeals.
Codes mentioned
63055630646306663077630786317263173632956318563190
Original notice
Spinal Decompression Surgery - MEDICAID - VIRGINIA (New)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Spinal Decompression Surgery - MEDICAID - KENTUCKY (New)HighEffective Oct 7, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - FLORIDA (New)HighEffective Sep 16, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - MICHIGAN (New)HighEffective Jul 22, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - INDIANA (New)HighEffective Jul 22, 2026 · MedicaidBrowse every Humana change in the policy list