MedicaidCoverageMedium impact
Prostate Artery Embolization - MEDICAID - INDIANA (New)
Humana·IN · Urology, Radiology·Medicaid
Effective date
Aug 26, 2026
We identified it
Aug 27, 2026
Summary
Humana Indiana Medicaid now covers Prostate Artery Embolization (PAE) for two indications: prostate hemorrhage, or benign prostatic hyperplasia in patients with prostate >80g who are not surgical candidates and have no history of prostate or bladder cancer. This is a NEW policy effective 08/26/2026, requiring billing teams to implement coverage criteria validation and prior authorization processes for CPT 37242 and 37243.
Action Required
By August 26, 2026: Billing team must implement the following for Indiana Medicaid claims: (1) Update billing system to recognize CPT 37242 and 37243 as covered procedures for PAE when submitted to Humana Indiana Medicaid; (2) Create prior authorization requirement workflow that validates: patient has prostate hemorrhage OR prostate size >80g with no prostate/bladder cancer history AND not a surgical candidate; (3) Add documentation checklist to encounter forms requiring: prostate size measurement, surgical candidacy assessment, and cancer history confirmation; (4) For members under age 21, flag all PAE requests for medical necessity review per EPSDT requirements. Claims submitted without meeting these criteria or lacking required documentation will be denied. Providers and billing staff must coordinate to ensure all supporting clinical documentation is attached to authorization requests.