Medicare AdvantageBilling CodesMedium impact
Prostatectomy - Medicare Advantage (Revised)
Humana·Urology, Oncology·Medicare Advantage
Effective date
Feb 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their prostatectomy coverage policy with new CPT codes 55868 and 55869 effective January 1, 2026. The policy clarifies coverage criteria for prostatectomy procedures including localized prostate cancer requirements and life expectancy minimums.
Action Required
By February 2, 2026: Billing team must update system to include new CPT codes 55868 and 55869 for laparoscopic prostatectomy procedures. Update encounter forms and billing software to verify coverage criteria are met: localized prostate cancer (T1-T3), life expectancy 10+ years, no distant metastases, and no regional lymph node involvement. Claims not meeting these criteria may be denied as medically unnecessary.