Medicare AdvantageCoverageMedium impact
Special Stains - Medicare Advantage (Revised)
Humana·Pathology, Oncology, Dermatology +3 more·Medicare Advantage
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated its Special Stains policy, providing comprehensive coverage criteria for histochemical and immunohistochemical stains used in pathology diagnosis. The policy establishes specific covered stains and references Local Coverage Determinations (LCDs) that vary by geographic jurisdiction for determining medical necessity.
Action Required
Before December 1, 2025: Billing team must review the specific Local Coverage Determination (LCD) for their geographic jurisdiction to ensure special stains billing meets medical necessity criteria. Update prior authorization workflows if required by local MAC guidelines. Verify that documentation supports the specific stains listed in the policy (Alcian blue-PAS, AMACR, Ki-67, etc.) before submitting claims for CPT codes 88312, 88313, 88314, 88319, 88341, 88342, 88344, 88360, and 88361.