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HumanaMedicaid · Prior Auth · Medicaid · LA · Wound Care, Podiatry, Vascular SurgeryHigh impact

Skin and Tissue Substitutes - MEDICAID - LOUISIANA (Revised)

Effective date
Oct 7, 2026
Identified
Oct 2, 2026

Summary

Humana's revised Louisiana Medicaid policy on skin and tissue substitutes covers these products only for partial and full-thickness diabetic lower extremity ulcers that meet a list of criteria, and it requires prior authorization with documentation that every criterion is met. It also limits coverage to 10 treatments in a 12-week period, stops coverage after five applications with no measurable decrease in wound size or depth, and bars using two products at once or hyperbaric oxygen at the same time. The source states an effective date of 10/07/2026, which has already passed, so confirm the policy is still the current version before relying on it.

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What to do

Action · 4 steps
01Already effective 2026-10-07 (this date has passed, so confirm the policy is still the current version): Billing team, in the prior auth tracker, before billing any skin substitute (HCPCS Q4101, Q4121, Q4160, Q4186, Q4195, or Q4196) for Humana Healthy Horizons Louisiana Medicaid members: confirm prior authorization is on file and that the chart shows the ulcer is at least 1.0 square cm and has lasted at least four weeks without measurable healing, that HbA1c is 9% or lower within the last 90 days (or a documented plan to get there), that there is no untreated infection, and that circulation is confirmed (ABI at least 0.7, TBI at least 0.5, TcPO2 at least 30 mm Hg, or biphasic or triphasic ankle waveforms).
02Providers and wound care staff: document the comprehensive treatment plan (offloading, smoking cessation, edema control, diabetes and nutrition improvement, and comorbidity monitoring) in the chart.
03Charge entry: track the number of applications and do not bill more than 10 treatments in 12 weeks, stop after five applications with no measurable decrease, do not schedule two products together, and do not schedule hyperbaric oxygen at the same time.
04The policy says all other indications are not medically necessary.

Codes mentioned

Q4101Q4121Q4160Q4186Q4195Q4196

Original notice

Skin and Tissue Substitutes - MEDICAID - LOUISIANA (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Skin and Tissue Substitutes - MEDICAID - LOUISIANA (Revised)MediumEffective Oct 7, 2026 · MedicaidApplied Behavior Analysis - MEDICAID - LOUISIANA (Revised)HighEffective Oct 7, 2026 · MedicaidSkin and Tissue Substitutes - MEDICAID - LOUISIANA (New)HighEffective Nov 12, 2025 · MedicaidSkin and Tissue Substitutes - MEDICAID - ILLINOIS (New)MediumEffective May 22, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesLA policy changesWound CarePodiatryVascular SurgeryCode Q4101Code Q4121Code Q4160Code Q4186Code Q4195Code Q4196

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