J2950 Insurance Policy Changes

Growth Hormone (Revised)

Humana has revised its Growth Hormone (GH) therapy coverage policy for Medicare Advantage, effective January 1, 2021, with major updates as of August 27, 2025. The policy establishes comprehensive prior authorization requirements for 17 GH products across pediatric and adult indications, with specific diagnostic criteria, stimulation test requirements, and preferred product designation (Omnitrope). Billing teams must implement prior authorization workflows and ensure claims include required clinical documentation for diagnosis confirmation.