Medicare AdvantageCoverageLow impact
Gastric Pacing and Gastric Electrical Stimulation - Medicare Advantage (Revised)
Humana·Gastroenterology, General Surgery·Medicare Advantage
Effective date
Mar 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their coverage policy for gastric electrical stimulation (GES) devices used to treat gastroparesis. The policy establishes specific medical necessity criteria for implantation, revision, removal, and replacement of GES devices, while explicitly excluding coverage for gastric pacing and temporary GES trials.
Action Required
Before March 2, 2026: Billing team must update prior authorization requirements for GES procedures (CPT 43647, 43648, 43881, 43882, 64590, 64595) for Humana Medicare Advantage members. Ensure documentation includes confirmation of gastroparesis via gastric emptying scintigraphy, patient age 18-70, absence of concurrent opioid use, and failure of conservative treatments. Stop submitting claims for gastric pacing or temporary GES trials as these are not covered.