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HumanaMedicaid · Coverage · Medicaid · SC · Pediatrics, Physical Therapy, Occupational Therapy +2 moreMedium impact

Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - SOUTH CAROLINA (Revised)

Effective date
Aug 26, 2026
Identified
Aug 25, 2026

Summary

Humana updated its South Carolina Medicaid DME/MSEA coverage policy effective 08/26/2026, establishing specific medical necessity criteria for durable medical equipment and clarifying coverage determinations for common items like pediatric walkers, hospital beds, and compression therapy devices. The policy explicitly denies coverage for several items (UpSee Mobility Device, Splashy Bath Seat, Safety Sleep Beds, Snoo Smart Sleep Bassinet, and Flexitouch Plus System) due to insufficient clinical evidence. Billing teams must familiarize themselves with these non-covered items and the reinforced criteria requiring provider documentation, medical necessity substantiation, and cost-effectiveness determinations.

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What to do

Action · 7 steps
01By 08/26/2026, the billing team must.
02Update the DME/MSEA approval matrix in the billing system to reflect non-covered items: UpSee Mobility Device (E1399), Splashy Bath Seat (E1399), Safety Sleep Beds including Abrams Safety Sleeper, Courtney Bed, Cubby Plus, Safe Haven, Sleep Safe Bed (E1399), Snoo Smart Sleep Bassinet (E1399), and Flexitouch Plus System (E0659).
03These items should trigger automatic denial with reference to this policy.
04Configure prior authorization requirements to mandate provider documentation of medical necessity for all remaining covered DME items, including specific functional limitations justifying the equipment.
05Educate providers that duplicate equipment (same function for multiple locations like school or work) and non-medically necessary add-ons/upgrades are not covered.
06Train billing staff on replacement criteria: equipment generally not replaced more frequently than every 5 years unless condition changes or irreparable damage occurs; repairs covered only if warranty expired and repair cost is less than replacement.
07Update denial reason codes to distinguish between items explicitly listed as not medically necessary versus those requiring prior auth.
If missed: Failure to implement these changes will result in claim denials and potential member billing issues.

Codes mentioned

E1399E0302E0304E0301E0303E0912E0659

Original notice

Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - SOUTH CAROLINA (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Medical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - KENTUCKY (Revised)HighEffective Sep 23, 2026 · MedicaidMedical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - OKLAHOMA (Revised)MediumEffective Jul 8, 2026 · MedicaidMedical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - SOUTH CAROLINA (New)MediumEffective May 6, 2025 · MedicaidMedical Supplies, Equipment and Appliances Durable Medical Equipment - MEDICAID - FLORIDA (New)MediumEffective Jun 13, 2025 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesSC policy changesPediatricsPhysical TherapyOccupational TherapyNeurologyGeneral PracticeCode E1399Code E0302Code E0304Code E0301Code E0303Code E0912Code E0659

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