Medicare AdvantageCoverageHigh impact
Upper and Lower Extremity Magnetic Resonance Imaging (MRI) - Medicare Advantage (Revised)
Humana·Orthopedics, Radiology, Rheumatology +2 more·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated medical necessity criteria for upper and lower extremity MRI (CPT codes 73221, 73222, 73223, 73722, 73723), requiring first-line imaging completion and specific clinical indications. The policy provides detailed coverage criteria for various conditions including bone infections, tumors, joint issues, and soft tissue abnormalities.
Action Required
Before April 1, 2026: Billing team must update prior authorization processes to ensure first-line imaging (X-ray, ultrasound) is documented before ordering extremity MRIs (CPT 73221-73223, 73722-73723) for Humana Medicare Advantage members. Providers must review and document specific medical necessity criteria from the policy's comprehensive list. Update EMR templates to include required clinical indications checklist. Claims without proper documentation and first-line imaging will be denied.