Medicare AdvantageCoverageMedium impact
Single Gene and Molecular Biomarker Testing for Solid Tumors - Medicare Advantage (Revised)
Humana·Oncology, Pathology, Hematology·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its policy for single gene and molecular biomarker testing for solid tumors, effective May 1, 2026. This policy covers genetic tests like FGFR, KRAS, NRAS, and molecular biomarkers like PD-L1 expression used to guide targeted cancer therapies.
Action Required
By May 1, 2026: Billing team must review and update prior authorization procedures for single gene and molecular biomarker testing for solid tumor patients with Humana Medicare Advantage plans. Verify coverage requirements for tests including FGFR, KIT, KRAS, MET, NRAS, NTRK, PDGFRA, PIK3CA, RET, ROS1, TERT, TP53, PD-L1, FOLR1, and TMB testing. Update billing software to reflect revised policy HUM-1236-003.