Skin and Tissue Substitutes - MEDICAID - INDIANA (New)

Already effective 2026-05-20: Verify whether the practice has implemented Humana Indiana Medicaid coverage restrictions for skin and tissue substitutes (HCPCS codes A2001–A2035, A4100, C9354, C9358–C9364, Q4101–Q4105) and confirm current applicability. Billing team must ensure that prior authorization or claims submissions for these products now comply with the two covered indications only: (1) diabetic foot ulcers >4 weeks duration meeting all stated clinical criteria (offloading, comprehensive assessment, diabetes diagnosis, repositioning, moist dressings, infection treatment, glycemic control), and (2) chronic venous leg ulcers >4 weeks duration meeting all stated criteria (clinical history, vascular assessment, compression therapy, moist dressings, infection treatment, glycemic control if diabetic). All other indications must be denied as not medically necessary. Review current claim submissions and billing software logic to confirm denials are issued correctly for out-of-scope uses (e.g., breast reconstruction, burn treatment, ocular defects, plantar fasciitis, surgical wounds). Confirm EPSDT medical necessity review is applied for members under age 21. Update internal authorization workflows and claim templates to reflect these limitations.