Back to dashboard
Medicare AdvantageCoverageMedium impact

Advanced Imaging of the Head and Neck - Medicare Advantage (Revised)

Humana·IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, CA, HI, NV, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR · Radiology, Neurology, Neurosurgery +1 more·Medicare Advantage
Effective date
Mar 2, 2026
We identified it
Jun 24, 2026
Days to comply
—

Summary

Humana has revised their Medicare Advantage policy for advanced imaging of the head and neck, establishing specific medical necessity criteria for MRA and MRI procedures. The policy provides jurisdiction-specific coverage determinations and clarifies when high-risk intracranial aneurysmal screening MRA is considered medically necessary.

Action Required

Action needed
Before March 2, 2026: Billing team must update prior authorization processes for head and neck MRI/MRA procedures to align with new medical necessity criteria. Ensure documentation supports coverage requirements, particularly for high-risk intracranial aneurysmal screening MRA which requires either autosomal dominant polycystic kidney disease history OR two or more family members with intracranial aneurysm/subarachnoid hemorrhage. Update encounter forms to capture these specific indications to prevent claim denials.

Affected Billing Codes

70543
70544
70545
70546
70547
70548
70549

Related policy hubs

Humana policiesIL policy changesMN policy changesWI policy changesCT policy changesMA policy changesME policy changesNH policy changesNY policy changesRI policy changesVT policy changesCA policy changesHI policy changesNV policy changesAK policy changesAZ policy changesID policy changesMT policy changesND policy changesOR policy changesSD policy changesUT policy changesWA policy changesWY policy changesAR policy changesCO policy changesLA policy changesMS policy changesNM policy changesOK policy changesTX policy changesDE policy changesDC policy changesMD policy changesNJ policy changesPA policy changesAL policy changesGA policy changesTN policy changesNC policy changesSC policy changesVA policy changesWV policy changesFL policy changesPR policy changesRadiologyNeurologyNeurosurgeryENT (Ear, Nose & Throat)Code 70543Code 70544Code 70545Code 70546Code 70547Code 70548Code 70549