MedicaidPrior AuthMedium impact
Pluvicto (lutetium Lu 177 vipivotide tetraxetan) (New)
Humana·IN · Oncology, Nuclear Medicine, Radiation Oncology·Medicaid
We identified it
Aug 4, 2026
Summary
Humana Medicaid-Indiana has issued a new Prior Authorization policy for Pluvicto (lutetium Lu 177 vipivotide tetraxetan), a radiopharmaceutical therapeutic agent. Prior authorization is now required before administering this treatment to Indiana Medicaid members. Billing teams must implement prior auth verification workflows before claims submission to avoid denials.
Action Required
Immediately: Billing and clinical teams must establish prior authorization procedures for Pluvicto administrations to Medicaid-Indiana members. (1) Contact Humana Medicaid-Indiana through the provided policy URL or standard PA channels to obtain specific prior auth submission requirements, timeframes, and documentation needed. (2) Update billing software and EMR systems to flag all Pluvicto claims for prior authorization verification before submission. (3) Instruct providers and infusion center staff to submit prior auth requests before scheduling patient treatments—do not administer Pluvicto without approved authorization. (4) Create internal tracking to monitor PA approval status and expected turnaround times. (5) Obtain the specific CPT, HCPCS, and ICD-10 diagnosis codes applicable to Pluvicto from the detailed policy document (summary-only version does not specify codes). Failure to obtain prior authorization will result in claim denials and potential patient financial responsibility.