MedicaidCoverageMedium impact
Craniosacral Therapy - MEDICAID - OKLAHOMA (New)
Humana·OK · Physical Therapy, Occupational Therapy, Pediatrics +2 more·Medicaid
Effective date
Jul 8, 2026
We identified it
Jul 3, 2026
Summary
Humana Medicaid in Oklahoma (Policy HUM-OK-2656-000) has established that craniosacral therapy is NOT covered and is considered not medically necessary for all members. This is a new policy effective July 8, 2026. Billing teams must deny all claims for craniosacral therapy billed under CPT 97530 or any other code, except for members under age 21 where requests must be reviewed for EPSDT medical necessity.
Action Required
By July 8, 2026: Billing team must update billing software to automatically deny all craniosacral therapy claims (CPT 97530) for Oklahoma Medicaid members age 21 and older. For members under age 21, route claims to medical director for EPSDT medical necessity review before processing. Update claim scrubbing rules to flag any craniosacral therapy claims submitted under alternate codes (such as therapeutic activities codes 97530, 97161, 97162, etc.) with a denial reason stating 'Not medically necessary per Humana-OK policy HUM-OK-2656-000.' Notify all providers in Oklahoma Medicaid network that craniosacral therapy is not a covered service effective immediately. Document this policy in billing system reference materials. Failure to implement these denials may result in improper payments and compliance issues.