Medicare AdvantageCoverageMedium impact
Peripheral Artery Revascularization of the Lower Extremities - Medicare Advantage (Revised)
Humana·Vascular Surgery, Cardiology, Radiology·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated their Medicare Advantage policy for peripheral artery revascularization of the lower extremities, establishing new medical necessity criteria for atherectomy procedures and intravascular ultrasound. The policy provides specific coverage guidelines for endovascular treatments including angioplasty, stenting, and atherectomy procedures.
Action Required
Before May 1, 2026: Billing team must update prior authorization protocols for atherectomy procedures (CPT codes 37271, 37273, 37275, 37277, 37288, 37290, 37292, 37294) to ensure documentation of CLTI with Rutherford scale 4-6, in-stent restenosis, or threatened bypass graft. Update encounter forms to remind providers of new medical necessity criteria. Claims without proper documentation will be denied.