Medicare AdvantageCoverageMedium impact
Carpal Tunnel Syndrome Surgical Treatments - Medicare Advantage (Revised)
Humana·Orthopedics, Neurosurgery, Plastic Surgery·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated coverage criteria for carpal tunnel surgery, requiring specific documentation of moderate-severe disease and failed conservative treatment. Several adjunctive procedures and newer surgical techniques are explicitly excluded from coverage.
Action Required
Before February 2, 2026: Billing team must update pre-authorization requirements for carpal tunnel surgery (CPT 29848, 64721) to ensure documentation includes EMG/NCS results showing moderate-severe median nerve injury OR thenar atrophy OR clinical signs with positive provocative tests AND evidence of failed conservative treatment (4-week splint trial or corticosteroid injection). Stop billing CPT 64728 for balloon carpal tunnelplasty as it will be denied. Update encounter forms to remind providers of required documentation elements.