Medicare AdvantageCoverageMedium impact
Lung Transplant - Medicare Advantage (Revised)
Humana·Pulmonology, Cardiothoracic Surgery, Transplant Surgery·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their lung transplant coverage policy with revised medical necessity criteria and contraindications. The policy now includes specific survival probability requirements and comprehensive exclusion criteria for transplant candidates.
Action Required
Before June 1, 2026: Billing team must review and update lung transplant authorization procedures to align with new medical necessity criteria including >50% risk of death within 2 years or >80% likelihood of 5-year survival. Ensure all contraindications are documented and verified before submitting claims for CPT codes 32850-32854. Contact Humana Corporate Transplant Department at 1-866-421-5663 for any lung transplant-related questions.