Medium impact
Prostatectomy - Medicare Advantage (Revised)
Humana·Effective Jul 1, 2026
Humana Medicare Advantage has revised its prostatectomy coverage policy (effective 07/01/2026) to clearly define medical necessity criteria: prostatectomy is covered for localized prostate cancer (T1-T3) without fixation OR salvage therapy following radiation/brachytherapy/cryotherapy failure, provided patients have ≥10 year life expectancy, no distant metastases, and no regional lymph node involvement. Nerve grafts (CPT 64999) to prevent erectile dysfunction remain non-covered. Two new laparoscopic prostatectomy codes (55869, new effective 1/1/2026) have been added to the covered procedure list.