Medicare AdvantageCoverageMedium impact
Nuclear Imaging for Noncancer Indications - Medicare Advantage (Revised)
Humana·Nuclear Medicine, Radiology, Neurology +1 more·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their nuclear imaging policy for non-cancer conditions, providing specific criteria for PET and PET/CT scans including new coverage for beta amyloid imaging for Alzheimer's diagnosis. The policy clarifies when FDG PET/CT is considered medically necessary and establishes consistent criteria across all jurisdictions.
Action Required
Before April 1, 2026: Billing team must review and update prior authorization requirements for nuclear imaging CPT codes 78608, 78811-78816 for Medicare Advantage patients. Ensure documentation meets new medical necessity criteria for FDG PET/CT scans for dementia, seizures, and infection cases. Update billing system to reflect new beta amyloid PET coverage criteria for Alzheimer's diagnosis.