Medicare AdvantageCoverageMedium impact
Genetic Testing for Hereditary Ataxias - Medicare Advantage (Revised)
Humana·Genetics, Neurology·Medicare Advantage
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated its policy for genetic testing for hereditary ataxias, including Friedreich ataxia, spinocerebellar ataxia, and CANVAS syndrome. The policy establishes medical necessity criteria for genetic testing of the RFC1 gene and references jurisdiction-specific CMS guidelines that vary by state.
Action Required
Before December 1, 2025: Billing team must review the specific Medicare Administrative Contractor (MAC) Local Coverage Determinations for their jurisdiction when billing genetic testing for hereditary ataxias. Verify RFC1 gene testing (0378U) meets medical necessity criteria for CANVAS syndrome. Ensure proper documentation of clinical symptoms and family history is obtained before ordering tests.