Medicare AdvantageCoverageMedium impact
Liquid Biopsy - Medicare Advantage (Revised)
Humana·Oncology, Hematology, Pathology·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
This is a new comprehensive Medicare Advantage policy for liquid biopsy testing, effective May 1, 2026. The policy establishes coverage determinations for blood-based cancer tests including circulating tumor DNA (ctDNA) and circulating tumor cell (CTC) analysis, following Medicare requirements and various MAC Local Coverage Determinations.
Action Required
Before May 1, 2026: Billing team must review applicable MAC Local Coverage Determinations for liquid biopsy testing in their geographic jurisdiction to understand specific coverage criteria and coding requirements. Update billing procedures to ensure compliance with Medicare requirements that services must be reasonable and necessary for diagnosis and treatment. Coordinate with providers to establish documentation protocols for liquid biopsy test orders.