Medicare AdvantageCoverageMedium impact
Multiplex Pathogen Identification Panels for Infectious Disease - Medicare Advantage (Revised)
Humana·Infectious Disease, Pathology, Family Medicine +2 more·Medicare Advantage
Effective date
Nov 3, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its policy for multiplex pathogen identification panels for infectious disease testing, effective November 3, 2025. The policy outlines coverage determination requirements that follow Medicare guidelines and requires medical necessity criteria to be met for molecular diagnostic tests and laboratory-developed tests.
Action Required
Before November 3, 2025: Billing team must review current multiplex pathogen identification panel billing practices for Humana Medicare Advantage members. Ensure all molecular diagnostic tests (MDTs) and laboratory-developed tests (LDTs) for infectious disease meet the medical necessity criteria outlined in applicable Local Coverage Determinations (LCDs) for your geographic jurisdiction. Update billing procedures to verify coverage requirements based on your Medicare Administrative Contractor's jurisdiction before submitting claims.