MedicaidPrior AuthHigh impact
Cutaneous Vascular Lesion Removal - MEDICAID - KENTUCKY (New)
Humana·KY · Dermatology, Pediatrics, Plastic Surgery·Medicaid
Effective date
Sep 16, 2026
We identified it
Sep 15, 2026
Summary
Humana Kentucky Medicaid has issued a new policy (effective 09/16/2026) establishing coverage criteria for cutaneous vascular lesion removal procedures. Coverage requires either failed conservative treatment or contraindicated conservative treatment, PLUS documentation of functional impairment, recurrent bleeding/painful nodules, or ulceration. Prior authorization is mandatory for all three CPT codes (17106, 17107, 17108). Members under age 21 receive EPSDT review.
Action Required
By 09/16/2026: Billing team must implement prior authorization requirement for CPT codes 17106, 17107, and 17108 in the billing system for all Humana Kentucky Medicaid claims (Healthy Horizons line). Update claim submission workflows to route these codes for mandatory pre-authorization. Clinical staff must document failed conservative treatment (e.g., triamcinolone, propranolol, timolol, systemic corticosteroids) or medical contraindication, PLUS one of the following: functional impairment affecting vital structures (ears, eyes, larynx, mouth, nose) or function (breathing, eating, hearing, speaking, swallowing); recurrent bleeding/painful nodules on extremities/trunk; or ulceration. Update provider encounter templates and clinical documentation requirements to ensure all three elements are captured. For members under 21, flag for EPSDT medical necessity review. Failure to obtain prior authorization will result in claim denials.