Medicare AdvantageCoverageMedium impact
Cardiac Magnetic Resonance Imaging (MRI) - Medicare Advantage (Revised)
Humana·Cardiology, Radiology·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new medical necessity criteria for cardiac MRI procedures (CPT codes 75557, 75561, C9762) effective April 1, 2026. The policy defines specific clinical indications when cardiac MRI will be considered medically reasonable and necessary, including various cardiomyopathies, congenital heart disease, and ischemic heart disease scenarios.
Action Required
Before April 1, 2026: Billing team must review all cardiac MRI orders (CPT 75557, 75561, C9762) for Humana Medicare Advantage patients to ensure they meet the new medical necessity criteria. Update pre-authorization processes to verify clinical indications match policy requirements. Providers must document specific conditions like cardiomyopathy type, congenital heart disease details, or ischemic heart disease scenarios. Claims not meeting the defined criteria may be denied.