Medicare AdvantageCoverageMedium impact
Artificial Intervertebral Disc Replacement - Medicare Advantage (Revised)
Humana·AL, GA, TN, NC, SC, VA, WV · Orthopedics, Neurosurgery, Pain Management·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their artificial intervertebral disc replacement policy with revised coverage criteria for cervical and lumbar disc replacements. The policy provides detailed medical necessity requirements including age restrictions (≤60 years for lumbar), specific anatomical criteria, and mandatory 6-month conservative treatment failure documentation.
Action Required
Before April 1, 2026: Billing team must update prior authorization requirements for artificial disc replacement procedures. Ensure documentation includes all required criteria: patient age verification (≤60 for lumbar), imaging confirmation of degenerative disc disease, comprehensive contraindication screening, skeletal maturity documentation, 6-month conservative treatment failure records, and presurgical psychological evaluation. Update encounter forms to remind providers of these requirements. Claims missing required documentation will be denied.