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Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)
Effective date
Apr 1, 2026
Identified
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.
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What to do
Action · 2 steps
01Before 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.
02Update system edits to verify medical necessity documentation before claim submission.
Codes mentioned
96547965483682355880
Original notice
Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)MediumEffective Apr 1, 2026 · Medicare AdvantageHyperthermia and Ultrasound Based Ablative Cancer Treatments - Medicare Advantage (Revised)MediumEffective Oct 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list