Medicare AdvantageCoverageMedium impact
Nerve Stimulation for Fecal Incontinence - Medicare Advantage (Revised)
Humana·Gastroenterology, Urology, General Surgery +1 more·Medicare Advantage
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their nerve stimulation policy for fecal incontinence, covering sacral nerve stimulation procedures but explicitly excluding percutaneous tibial nerve stimulation as not medically necessary. The policy establishes specific criteria for device removal and replacement procedures.
Action Required
Before December 1, 2025: Billing team must update system to flag that CPT 64566 (percutaneous tibial nerve stimulation) is not covered for fecal incontinence by Humana Medicare Advantage. Ensure documentation requirements are met for sacral nerve stimulation procedures (64561, 64581, 64590, 64595) including contraindication screening. Update encounter forms to remind providers that PTNS is excluded for this indication.