Humana Medicare Advantage has updated their policy for proton beam, neutron beam, and carbon ion radiation therapy, establishing specific medical necessity criteria for proton beam therapy, limiting neutron beam therapy to inoperable salivary gland tumors, and excluding carbon ion therapy entirely. The policy also covers prostate rectal spacers with specific criteria.
Action Required
Action needed
Before March 2, 2026: Billing team must update prior authorization processes for proton beam therapy codes (77520, 77522, 77523, 77525) to verify medical necessity criteria per LCD L33937. Stop billing carbon ion radiotherapy entirely as it is not covered. For neutron beam therapy (77423), ensure documentation supports inoperable salivary gland tumor diagnosis. Update system to flag prostate rectal spacer procedures (55874) for criteria verification.