Medicare AdvantageCoverageMedium impact
Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)
Humana·Oncology, Urology, General Surgery·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated coverage criteria for hyperthermia and ultrasound-based ablative cancer treatments, establishing specific medical necessity requirements for HIPEC, ILI/ILP, laser therapy, and HIFU procedures. The policy provides detailed coverage determinations for various cancer treatment approaches including specific indications and patient criteria.
Action Required
Before April 1, 2026: Billing team must update prior authorization workflows to ensure HIPEC (96547, 96548) meets criteria including conjunction with cytoreductive surgery and specific cancer types, ILI/ILP (36823) is for stage III in-transit melanoma only, laser therapy (0970T, 0971T) requires IDE study enrollment, and HIFU (55880) meets salvage therapy criteria for recurrent prostate cancer. Update system edits to verify medical necessity documentation before claim submission.