Medicare AdvantageCoverageMedium impact
Molecular Biomarkers for Prostate Cancer Risk Stratification - Medicare Advantage (Revised)
Humana·Urology, Oncology, Family Medicine +1 more·Medicare Advantage
Effective date
Oct 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their molecular biomarkers policy for prostate cancer risk stratification, effective October 1, 2025. The policy covers various molecular tests including 4Kscore, PHI, PCA3, and other biomarkers used to risk-stratify patients and avoid unnecessary biopsies.
Action Required
Before October 1, 2025: Review current molecular biomarker testing procedures for prostate cancer patients on Humana Medicare Advantage plans. Verify that tests being ordered (4Kscore, PHI, PCA3, MyProstateScore 2.0, etc.) align with updated coverage criteria. Update prior authorization processes if required based on specific MAC jurisdictions. Ensure documentation supports medical necessity for molecular biomarker testing.