Medicare AdvantageCoverageMedium impact
Brachytherapy - Medicare Advantage (Revised)
Humana·Oncology, Radiation Oncology, Neurosurgery +2 more·Medicare Advantage
Effective date
Mar 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their brachytherapy coverage policy with revised medical necessity criteria for various cancer types including brain, breast, gynecologic, and other cancers. The policy provides detailed coverage determinations for different brachytherapy techniques and clarifies when treatments will be considered medically reasonable and necessary.
Action Required
Before March 2, 2026: Review current brachytherapy cases to ensure they meet the updated medical necessity criteria outlined in the revised policy. Update prior authorization processes to align with new coverage determinations for brain cancer (GammaTile), breast cancer (APBI criteria), and other specified indications. Train billing staff on the specific age, staging, and clinical requirements for each cancer type covered.