Medicare AdvantageCoverageHigh impact
Percutaneous Coronary Intervention - Medicare Advantage (Revised)
Humana·Cardiology, Cardiothoracic Surgery·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their Percutaneous Coronary Intervention policy, establishing specific medical necessity criteria for PCI procedures and determining that coronary intravascular lithotripsy (IVL) will not be covered as reasonable and necessary.
Action Required
Before February 2, 2026: Billing team must update prior authorization requirements for PCI procedures (CPT codes 92920, 92924, 92928, 92930, 92933, 92937, 92941, 92943, 92945) to ensure documentation supports one of five covered indications: acute coronary syndrome, chest pain despite optimal medical therapy, in-stent restenosis with symptoms, recent STEMI with non-infarct artery, or silent ischemia. Stop billing coronary intravascular lithotripsy codes (92972, C1761, C7571) as these are now considered non-covered services and claims will be denied.