MedicaidCoverageMedium impact
Cardiac Stress Testing - MEDICAID - SOUTH CAROLINA (New)
Humana·SC · Cardiology, Nuclear Medicine, Oncology +1 more·Medicaid
Effective date
Aug 26, 2026
We identified it
Aug 25, 2026
Summary
Humana has issued a new Medicaid cardiac stress testing policy for South Carolina that establishes comprehensive coverage criteria for myocardial perfusion imaging (MPI) and stress testing procedures. The policy covers cardiac stress testing (CPT 78466, 78468, 78469 and HCPCS A9611) for specific clinical indications including diagnosis of suspected coronary artery disease, heart failure evaluation, post-intervention assessment, viability testing, oncology cardiac risk stratification, and congenital heart disease assessment, effective immediately with no prior authorization mechanism specified.
Action Required
By August 26, 2026: Billing team must update cardiac stress testing billing rules and claim submission workflows to reflect new Humana Medicaid South Carolina policy HUM-SC-2658-000. (1) Load CPT codes 78466, 78468, 78469 and HCPCS code A9611 into billing system with South Carolina Medicaid payor record. (2) Update internal billing guidelines to document which clinical indications qualify for coverage (symptomatic CAD evaluation, heart failure assessment, post-intervention workup, viability testing, oncology cardiac risk stratification, congenital heart disease evaluation). (3) Create or update claim submission checklist to require provider documentation supporting one of the approved indications listed in policy before submitting claims. (4) Flag claims lacking adequate medical necessity documentation for provider follow-up before billing. (5) Review any denied cardiac stress testing claims from 08/26/2026 forward under this new policy authority. Train billing staff on the 14 distinct covered scenarios. Note: Policy document does not specify prior authorization requirements; monitor for potential updates or contact Humana directly for authorization procedures. Failure to align with this coverage determination may result in claim denials or payment reversals.