Medicare AdvantageCoverageMedium impact
Uterine Fibroid Surgical Treatments - Medicare Advantage (Revised)
Humana·OB-GYN, General Surgery, Radiology·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their uterine fibroid surgical treatment policy, establishing specific medical necessity criteria for covered procedures (hysterectomy, radiofrequency ablation, myomectomy, UAE/UFE) while excluding coverage for cryoablation, MRgFUS/HIFU, and uterine artery ligation due to insufficient evidence.
Action Required
Before April 1, 2026: Billing team must update prior authorization protocols to ensure all uterine fibroid procedures meet new medical necessity criteria - confirmed fibroids via imaging/sampling AND 3+ months of persistent symptoms despite medical management. Update denial management protocols as cryoablation (58578, 58579, 58999), MRgFUS/HIFU (0071T, 0072T), and uterine artery ligation (37243) will be denied as non-covered. For UAE/UFE, RFA, and myomectomy, documentation must also show patient desires uterine-sparing procedure.