MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - INDIANA (Revised)
Humana·IN · Cardiology, Cardiothoracic Surgery, Critical Care +2 more·Medicaid
Effective date
Oct 28, 2026
We identified it
Oct 26, 2026
Summary
Humana Medicaid in Indiana revised its Cardiac Devices policy effective 2026-10-28, updating coding information and coverage criteria for implantable cardioverter-defibrillators (ICDs) and mobile cardiac outpatient telemetry (MCOT). The policy clarifies coverage for MCOT under specific clinical indications (infrequent symptoms plus either recurrent unexplained syncope or suspected paroxysmal atrial fibrillation for cryptogenic stroke) and lists specific HCPCS codes for device components.
Action Required
Effective 2026-10-28, the billing team should verify that claims submission templates and prior authorization protocols for Indiana Medicaid cardiac device cases reflect the updated coverage criteria. Specifically: (1) Update billing system documentation to ensure ICD claims use the correct HCPCS codes (C1721, C1722, C1777, C1882, C1895, C1896, C1899, C1900) based on device type; (2) Implement clinical documentation requirements for MCOT (CPT 93228, 93229) that mandate evidence of infrequent symptoms occurring less frequently than once every 48 hours AND either recurrent unexplained syncope with suspected arrhythmic etiology or suspected paroxysmal atrial fibrillation as cause of cryptogenic stroke; (3) Ensure prior authorization requests for MCOT include the specific clinical indication and documentation that initial evaluation was nondiagnostic (for syncope cases); (4) For members under age 21, confirm that MCOT requests are reviewed for medical necessity per EPSDT requirements. Failure to align documentation with these specific indications may result in claim denials or requests for additional information.