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HumanaMedicaid · Prior Auth · Medicaid · KY · Neurosurgery, Orthopedics, Pain ManagementHigh impact

Spinal Decompression Surgery - MEDICAID - KENTUCKY (New)

Effective date
Oct 7, 2026
Identified
Oct 15, 2026

Summary

Humana Kentucky Medicaid has issued a new spinal decompression surgery coverage policy (HUM-KY-2660-000) effective 2026-10-07, establishing medical necessity criteria for discectomy, laminectomy, foraminectomy, and related procedures. The policy specifies coverage requirements including diagnostic imaging confirmation, clinical symptoms, and conservative treatment trial periods (6 weeks for herniated disc with radicular pain). Prior authorization is required for all covered services under this policy.

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What to do

Action · 4 steps
01Effective 2026-10-07: Billing team must implement prior authorization requirements for all spinal decompression procedures covered under this policy (CPT codes 63055, 63064, 63066, 63077, 63078, 63172, 63173, 63295, 63185, 63190) in the billing system for Kentucky Medicaid members.
02Verify that encounter forms and clinical documentation capture required elements: diagnostic imaging confirmation, clinical symptoms, neurological signs, and documentation of 6-week conservative treatment trial (epidural injections, medications, or physical therapy) for herniated disc cases with radicular pain.
03Update internal clinical decision support tools to reflect the specific coverage criteria outlined in policy HUM-KY-2660-000.
04Confirm that prior authorization denials will result if medical necessity criteria are not met; claims submitted without meeting documented criteria will be denied by Humana Kentucky Medicaid.

Codes mentioned

63055630646306663077630786317263173632956318563190

Original notice

Spinal Decompression Surgery - MEDICAID - KENTUCKY (New)
mcp.humana.com · Always check the source before changing claims.
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Related changes

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Spinal Decompression Surgery - MEDICAID - FLORIDA (New)HighEffective Sep 16, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - VIRGINIA (New)HighEffective Jul 22, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - MICHIGAN (New)HighEffective Jul 22, 2026 · MedicaidSpinal Decompression Surgery - MEDICAID - INDIANA (New)HighEffective Jul 22, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesKY policy changesNeurosurgeryOrthopedicsPain ManagementCode 63055Code 63064Code 63066Code 63077Code 63078Code 63172Code 63173Code 63295Code 63185Code 63190

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