Medicare AdvantageCoverageMedium impact
Serological and Fecal Testing for Inflammatory Bowel Disease - Medicare Advantage (Revised)
Humana·Gastroenterology, Internal Medicine, Family Medicine·Medicare Advantage
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their policy for serological and fecal testing for Inflammatory Bowel Disease (IBD), including tests like ASCA, pANCA, and drug monitoring assays. Coverage follows CMS guidance and MolDX requirements, with tests needing to demonstrate analytical validity, clinical validity, and clinical utility.
Action Required
Before June 1, 2026: Review IBD testing orders to ensure they meet CMS and MolDX requirements for analytical and clinical validity. Verify that serological tests (ASCA, pANCA, AntiOmp C) and fecal inflammatory markers are supported by appropriate clinical documentation demonstrating medical necessity. Update prior authorization processes to align with applicable LCD/LCA requirements in your MAC jurisdiction.