High impact
Spinal Decompression Surgery - MEDICAID - SOUTH CAROLINA (Revised)
Humana·Effective Jul 22, 2026
Humana revised its South Carolina Medicaid spinal decompression surgery coverage policy effective July 22, 2026, establishing specific medical necessity criteria for discectomy, laminectomy, foraminectomy, and related procedures. The policy defines coverage requirements based on diagnosis (herniated disc, myelopathy, fractures, infections, tumors), requires documented conservative treatment failure (6 weeks minimum), and specifies clinical and objective findings needed for approval. Billing teams must ensure prior authorization requests include diagnostic imaging confirmation and evidence of conservative treatment attempts before surgery.