MedicaidPrior AuthMedium impact
Excessive Skin and Subcutaneous Tissue Removal - MEDICAID - KENTUCKY (New)
Humana·KY · Plastic Surgery, General Surgery, Dermatology·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 21, 2026
Summary
Humana Kentucky Medicaid has established new coverage criteria for excessive skin and subcutaneous tissue removal procedures. Coverage now requires: (1) functional impairment from excess skin/tissue, (2) medical complications unrelieved by 12+ weeks of prescribed dermatological therapy, and (3) stable body weight maintained for 6+ months. Prior authorization is mandatory for all applicable procedures. This is a NEW policy effective 07/22/2026.
Action Required
By 07/22/2026: (1) Billing team must implement mandatory prior authorization requirement for CPT codes 15832, 15834, 15835, 15836, and 15839 in all billing system workflows for Humana Kentucky Medicaid (Healthy Horizons). (2) Update encounter forms and provider templates to require documentation of: functional impairment, medical complications, 12+ weeks of failed conservative dermatological treatment, and 6+ months of stable body weight post-weight loss. (3) Configure system to reject/hold claims for these codes without prior authorization. (4) Train billing staff that cosmetic procedures or requests without meeting all three criteria will be denied. (5) Inform plastic surgery providers of new documentation requirements for claim submission. Claims submitted without meeting coverage criteria or prior authorization will be denied.