Medicare AdvantageCoverageMedium impact
Skin and Tissue Substitutes - Medicare Advantage (Revised)
Humana·KY, OH, AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, FL · Wound Care, Plastic Surgery, General Surgery +2 more·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana updated their Medicare Advantage policy for skin and tissue substitutes/cellular and tissue-based products (CTPs), establishing coverage criteria for specific products like AlloDerm, Apligraf, and Epifix. The policy defines medical necessity requirements based on local coverage determinations for diabetic foot ulcers, venous leg ulcers, breast reconstruction, and burn treatment.
Action Required
Before May 1, 2026: Billing team must review and update prior authorization processes for skin substitute procedures to align with new Humana Medicare Advantage coverage criteria. Update billing software to flag Q4116, Q4151, Q4101, A4100, C1763, Q4122, Q4186, and Q4128 codes for medical necessity documentation requirements specific to diabetic foot ulcers, venous leg ulcers, breast reconstruction, or burn treatment indications.