Medicare AdvantageCoverageMedium impact
Left Atrial Appendage and Cardiac Structural Defect Closure - 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 medical necessity criteria for cardiac structural defect closures, including left atrial appendage closure, patent foramen ovale closure, and atrial septal defect repair. The policy establishes specific coverage requirements and contraindications for both surgical and percutaneous approaches.
Action Required
Before February 2, 2026: Billing team must review and update prior authorization processes for cardiac structural defect closure procedures. Ensure documentation includes CHA2DS2-VASc scores for LAA closure, age verification for PFO closure (18-60 years), and all required contraindication assessments. Update encounter forms to prompt providers for necessary clinical criteria documentation to meet medical necessity requirements.