MedicaidPrior AuthMedium impact
Zusduri (mitomycin) (Revised)
Humana·IN · Urology, Oncology·Medicaid
Effective date
Oct 1, 2025
We identified it
Sep 2, 2026
Summary
This is a new Humana Medicaid (Indiana) prior authorization policy for Zusduri (mitomycin) intravesical instillation for recurrent low-grade intermediate-risk non-muscle invasive bladder cancer. Coverage requires prior auth, patient must have documented recurrent disease, have not received prior Zusduri therapy (max 6 doses), and must not have bladder perforation. Initial and renewal approvals cover 6 months (maximum 6 doses per period).
Action Required
By October 1, 2025: Billing team must implement prior authorization requirements for all Zusduri (mitomycin) intravesical kit and Sterile Hydrogel claims submitted to Humana Medicaid Indiana. Before submitting claims, verify: (1) member has LG-IR-NMIBC diagnosis with documented recurrent disease, (2) member has not received prior Zusduri therapy, (3) member does not have bladder perforation. Update billing software and provider encounter templates to flag Zusduri requests for prior auth submission. Contact Humana PAL at www.humana.com/PAL to obtain specific medical and procedural billing codes. Without prior authorization, claims will be denied. Educate urology providers in Indiana about the new requirement.