Medicare AdvantageCoverageMedium impact
Sinonasal and Eustachian Tube Surgical Procedures - Medicare Advantage (Revised)
Humana·ENT (Ear, Nose & Throat)·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated coverage criteria for sinonasal and eustachian tube surgical procedures, establishing specific medical necessity requirements for balloon dilation procedures, functional endoscopic sinus surgery, and related interventions. The policy defines detailed documentation requirements including physical exams, diagnostic workup, and failed medical therapy before surgical intervention will be covered.
Action Required
Before April 1, 2026: Billing team and providers must update documentation requirements for sinonasal procedures. Ensure all claims include evidence of failed medical therapy, diagnostic workup results (CT scans, endoscopic exams), and specific symptom duration criteria. Update prior authorization workflows to verify 18+ age requirement and chronic condition lasting >12 weeks. Claims missing required documentation will be denied.