Medicare AdvantageCoverageMedium impact
Carotid Revascularization - Medicare Advantage (Revised)
Humana·Vascular Surgery, Neurosurgery, Cardiothoracic Surgery +1 more·Medicare Advantage
Effective date
Jan 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their carotid revascularization policy, establishing specific coverage criteria for carotid endarterectomy procedures. The policy defines medical necessity requirements based on stenosis severity and symptom status, with clear exclusions for mild stenosis and severe disability cases.
Action Required
Before January 2, 2026: Review all carotid endarterectomy (CPT 35301) cases to ensure documentation meets new criteria - symptomatic patients need ≥50% stenosis, asymptomatic patients need ≥70% stenosis. Update prior authorization workflows to verify stenosis percentage via imaging studies. Cases with <50% stenosis, total occlusion, or severe disability will be denied coverage.