Medicare AdvantageCoverageMedium impact
Intensity Modulated Radiation Therapy - Medicare Advantage (Revised)
Humana·AL, GA, TN, NC, SC, VA, WV · Radiation Oncology, Urology, Oncology·Medicare Advantage
Effective date
Mar 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their Intensity Modulated Radiation Therapy (IMRT) policy with revised coverage criteria and coding information. The policy establishes specific medical necessity criteria for prostate rectal spacers and provides comprehensive coding guidance for IMRT procedures.
Action Required
Before March 2, 2026: Billing team must update prior authorization requirements for prostate rectal spacers (CPT 55874) to ensure documentation shows patient is undergoing prostate cancer radiation treatment with no posterior extraprostatic extension or rectal wall invasion. Update billing system with new IMRT coding requirements and ensure proper documentation for medical necessity criteria.