Medicare AdvantageCoverageMedium impact
Breast Reconstruction - Medicare Advantage (Revised)
Humana·Plastic Surgery, General Surgery, Oncology·Medicare Advantage
Effective date
Nov 11, 2025
We identified it
Jun 24, 2026
Summary
This is a comprehensive revision of Humana's Medicare Advantage breast reconstruction policy covering coverage determinations, coding, and procedures for reconstruction following mastectomy or trauma. The policy provides detailed guidance on autologous tissue reconstruction, implants, and related technologies including tissue perfusion assessment methods.
Action Required
By November 11, 2025: Review and update billing procedures for breast reconstruction services to align with revised Humana Medicare Advantage policy HUM-1030-005. Ensure familiarity with covered reconstruction techniques, tissue perfusion assessment technologies, and related procedures. Update prior authorization processes if required and verify appropriate documentation requirements for breast reconstruction claims.