Medicare AdvantageCoverageHigh impact
Advanced Imaging of the Spine - Medicare Advantage (Revised)
Humana·Orthopedics, Neurosurgery, Pain Management +3 more·Medicare Advantage
Effective date
May 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their advanced imaging policy for spinal CT, MRI, and MRA procedures, establishing specific medical necessity criteria including red flag conditions and clinical indicators that must be documented for coverage approval.
Action Required
Before May 1, 2025: Providers must document specific red flag conditions and clinical indicators when ordering spinal CT scans (CPT 72126, 72127, 72130, 72132, 72133) for Humana Medicare Advantage patients. Update EMR templates to include required red flag symptoms like urinary retention, bilateral weakness, constitutional symptoms, history of cancer, steroid use, trauma history, and infection risk factors. Claims without proper medical necessity documentation will be denied.