Medicare AdvantageCoverageMedium impact
Brain Functional Magnetic Resonance Imaging (fMRI) - Medicare Advantage (New)
Humana·Neurology, Neurosurgery, Radiology +1 more·Medicare Advantage
Effective date
Jan 2, 2026
We identified it
Jun 24, 2026
Summary
New Medicare Advantage policy establishes coverage criteria for brain functional MRI (fMRI) procedures. Coverage is approved for specific indications including presurgical planning, assessment of brain tumors, epilepsy surgery evaluation, and eloquent cortex mapping.
Action Required
Before January 2, 2026: Billing team must update prior authorization processes for CPT codes 70554 and 70555 to ensure medical necessity documentation meets the new criteria. Providers must document one of the nine approved indications (tumor assessment, presurgical planning, eloquent cortex evaluation, epilepsy surgery, etc.) in medical records. Claims without proper justification will be denied.