MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - VIRGINIA (Revised)
Humana·VA · Cardiology, Cardiothoracic Surgery, Critical Care +1 more·Medicaid
Effective date
Oct 28, 2026
We identified it
Oct 26, 2026
Summary
Humana Virginia Medicaid updated its Cardiac Devices policy effective 2026-10-28, revising coverage criteria for implantable cardiac devices. The policy continues to cover cardioverter-defibrillators with leads, wireless pulmonary artery pressure sensors, and mobile cardiac outpatient telemetry under specific medical necessity criteria, while maintaining non-coverage of cardiac contractility modulation and carotid sinus baroreflex activation systems due to insufficient clinical evidence.
Action Required
Effective 2026-10-28: Billing team should verify current applicability of this revised Humana Virginia Medicaid cardiac devices policy and confirm whether the practice has implemented the coverage determinations in its billing system. Key actions: (1) Ensure billing software correctly processes covered codes (C1721, C1722, C1777, C1882, C1895, C1896, C1899, C1900 for cardioverter-defibrillators and leads; C2624 and 93264 for wireless pulmonary artery pressure sensors; 93228 and 93229 for mobile cardiac outpatient telemetry) as eligible only when medically necessary; (2) Confirm that codes C1824 (cardiac contractility modulation) and C1825 (carotid sinus baroreflex activation) remain marked as non-covered with appropriate denial messaging citing insufficient clinical evidence; (3) Review MCOT eligibility requirements (infrequent/unpredictable symptoms plus specific arrhythmia indications) to ensure prior authorization reviewers and billing staff apply correct medical necessity criteria; (4) For members under age 21, verify EPSDT requirements are being applied during medical necessity review. Contact Humana for current policy documentation to confirm no subsequent updates have superseded this 2026-10-28 version.