MedicaidPrior AuthMedium impact
Cutaneous Vascular Lesion Removal - MEDICAID - KENTUCKY (New)
Humana·KY · Dermatology, Plastic Surgery, Pediatrics·Medicaid
Effective date
Sep 16, 2026
We identified it
Sep 16, 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 CPT codes 17106, 17107, and 17108.
Action Required
By September 16, 2026: Billing team must update billing system and prior authorization workflow to require prior auth for CPT 17106, 17107, and 17108 (cutaneous vascular lesion destruction) for all Humana Kentucky Medicaid claims. Providers must document: (1) failed conservative treatment (intralesional triamcinolone/betamethasone, oral propranolol, topical timolol, systemic corticosteroids, or local wound care) OR contraindication due to complex/high-risk lesion; AND (2) at least one of: functional impairment affecting vital structures/functions (ears, eyes, larynx, mouth, nose, breathing, eating, hearing, speaking, swallowing), recurrent bleeding or painful nodules on extremities/trunk, or ulceration. Update encounter templates and prior authorization request forms to capture this documentation. For members under 21, flag for EPSDT medical necessity review. Claims submitted without prior authorization or missing required documentation will be denied.