MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Cardiology, Internal Medicine·Medicaid
Effective date
Oct 28, 2026
We identified it
Oct 26, 2026
Summary
Humana Medicaid in South Carolina revised its cardiac devices policy effective 10/28/2026, updating coding information from the previous version issued 07/01/2025. The policy covers mobile cardiac outpatient telemetry (MCOT) for specific cardiac indications using CPT codes 93228 and 93229. Billing teams should verify current applicability of coverage criteria and ensure claims are submitted with the correct codes and medical necessity documentation.
Action Required
Already effective 2026-10-28: Verify whether the practice has implemented the updated Humana Medicaid South Carolina cardiac devices policy (HUM-SC-2011-001, version 001) and confirm current applicability. Billing team should: (1) Review coverage criteria for CPT 93228 and 93229, which require documented 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; (2) Ensure prior authorization requests for these codes include documentation of medical necessity aligned with policy indications; (3) For members under age 21, confirm EPSDT (Early and Periodic Screening, Diagnostic and Treatment) requirements are met before claim submission; (4) Update billing system templates or encounter forms to reflect the current coverage determination criteria.