Medicare AdvantageCoverageMedium impact
Headache and Occipital Neuralgia Treatments - Medicare Advantage (Revised)
Humana·Neurology, Pain Management, Neurosurgery·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated its coverage policy for headache and occipital neuralgia treatments, establishing specific criteria for occipital nerve stimulation and denervation procedures while explicitly excluding coverage for certain surgical interventions and stimulation devices for neck pain and tension headaches.
Action Required
Before June 1, 2026: Billing team must update prior authorization requirements for occipital nerve stimulation procedures (CPT 64553, 64555, 64575 and related HCPCS codes) to ensure they meet LCD L34328 criteria for occipital neuralgia, postsurgical neuropathic pain, cervicogenic headaches, and treatment-resistant migraines. Update billing system to deny claims for excluded procedures including nerve decompression surgeries (64708, 64716, 64744) and occipital nerve stimulation for neck pain or tension headaches. Train staff that these excluded services will not be covered and claims will be denied.