Medicare AdvantageCoverageMedium impact
Cardiac Pacemakers - Medicare Advantage (Revised)
Humana·Cardiology, Cardiothoracic Surgery·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their cardiac pacemaker coverage policy, effective February 2, 2026. The policy expands coverage criteria for permanent pacemakers to include additional indications like cardiac transplant with symptomatic bradycardia, hypertrophic cardiomyopathy with LVOT obstruction, and post-TAVR high-risk AV conduction cases.
Action Required
Before February 2, 2026: Billing team must review and update prior authorization criteria for cardiac pacemaker procedures to include the new covered indications (cardiac transplant with symptomatic bradycardia, hypertrophic cardiomyopathy with LVOT obstruction, conjunction with AVN ablation, and post-TAVR high-risk cases). Update documentation requirements in EMR templates to capture these specific medical necessity criteria for Humana Medicare Advantage patients.