Medicare AdvantageCoverageHigh impact
Comprehensive Genomic Profiling and Multigene Panel Testing for Solid Tumors - Medicare Advantage (Revised)
Humana·Oncology, Pathology, Hematology·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated their Medicare Advantage policy for comprehensive genomic profiling and multigene panel testing for solid tumors, with new coverage determination criteria and related pharmacy coverage policies. This policy will be effective April 1, 2026, replacing the current policy that has been in effect since January 1, 2024.
Action Required
By April 1, 2026: Billing teams must review and update prior authorization requirements and coverage criteria for comprehensive genomic profiling and multigene panel testing for solid tumors under Humana Medicare Advantage plans. Update billing software to reflect new policy HUM-1057-010 requirements. Coordinate with oncology providers to ensure compliance with new coverage determination criteria. Review related pharmacy coverage policies for targeted cancer therapies to ensure proper coordination between diagnostic testing and treatment authorization.