Medicare AdvantageCoverageMedium impact
Breast Imaging - Medicare Advantage (Revised)
Humana·Radiology, OB-GYN, Oncology +2 more·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their breast imaging coverage policy, establishing specific criteria for high-risk screening MRI and referencing updated CMS guidance for mammography, tomosynthesis, and other breast imaging services. The policy clarifies medical necessity criteria for diagnostic breast imaging across different jurisdictions.
Action Required
Before September 2, 2025: Review and update breast imaging authorization processes to align with new high-risk screening MRI criteria. Ensure documentation includes specific genetic mutations, family history details, lifetime risk calculations, or radiation exposure history for MRI requests. Update prior authorization templates to capture required criteria for BRCA1/BRCA2, TP53, ATM, CDH1, CHEK2, and other specified genetic conditions with appropriate age thresholds.