Medicare AdvantageCoverageMedium impact
Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)
Humana·IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH · Cardiology, Cardiothoracic Surgery·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated coverage criteria for cardiac catheterization and coronary angiography procedures (CPT 93454-93461), specifying detailed requirements for moderate to severe ischemia documentation and stress test results. The policy establishes specific thresholds for nuclear perfusion, echocardiogram, and other diagnostic tests that must be met for coverage approval.
Action Required
Before April 1, 2026: Billing team must update prior authorization workflows for cardiac catheterization procedures (CPT 93454-93461) to ensure documentation includes specific ischemia thresholds: nuclear perfusion ≥10% ischemic myocardium, echocardiogram ≥3/16 segments with severe hypokinesis, or CMR perfusion ≥12% ischemic myocardium. Train providers on new documentation requirements and update EMR templates to capture required stress test results and measurements.