Medicare AdvantageCoverageMedium impact
Nuclear Imaging for Cancer Indications - Medicare Advantage (Revised)
Humana·Oncology, Nuclear Medicine, Radiology·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their nuclear imaging policy for cancer indications, providing detailed coverage criteria for various PET scans including FDG, PSMA, and specialized radioactive agents. The policy clarifies coverage determination for breast cancer imaging with F-18 Fluoroestrodial and pulmonary nodule evaluation, effective June 1, 2026.
Action Required
Before June 1, 2026: Billing teams must update prior authorization requirements and coverage criteria for nuclear imaging procedures. Review and implement new medical necessity criteria for F-18 Fluoroestrodial PET scans for breast cancer patients and FDG PET for pulmonary nodules. Update billing system edits to align with NCD 220.6.17 requirements and ensure proper documentation for subsequent PET scans (5th scan or greater) per LCD L35391 criteria.