Humana Medicare Advantage updated their advanced chest imaging policy to include specific medical necessity criteria for CT scans (CPT 71260, 71270) including detailed guidelines for pulmonary nodule follow-up imaging and preoperative/postoperative indications. The policy provides structured protocols for managing incidental pulmonary nodules based on size, type, and risk factors.
Action Required
Action needed
Before June 1, 2026: Clinical and billing teams must review and implement the new medical necessity criteria for chest CT orders. Providers must ensure documentation aligns with the specific indications outlined in the policy including pulmonary nodule management protocols and preoperative requirements. Update prior authorization processes to reference the new LCD criteria from Palmetto GBA and Novitas Solutions based on geographic jurisdiction.