Medicare AdvantageCoverageHigh impact
Advanced Imaging of the Abdomen and Pelvis - Medicare Advantage (Revised)
Humana·Radiology, Gastroenterology, Oncology +4 more·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their medical coverage policy for advanced imaging of the abdomen and pelvis, establishing specific criteria for when CT and MRI scans are considered medically necessary. The policy provides detailed coverage determinations for various imaging procedures including CT enterography, MRCP, and MR enterography.
Action Required
Before June 1, 2026: Billing team must update prior authorization and medical necessity documentation requirements for abdominal and pelvic imaging CPT codes. Ensure providers document specific clinical criteria outlined in the policy (e.g., abnormal or nondiagnostic ultrasound for liver disease, unintentional weight loss >5% for occult malignancy). Update encounter forms and EMR templates to include required clinical justifications. Claims without proper documentation will be denied.