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Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage (Revised)

Humana·Oncology, Hematology·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
Jun 24, 2026
Days to comply

Summary

Humana Medicare Advantage has updated their CAR T-cell therapy policy with new CPT codes effective January 1, 2025, transitioning from temporary Category III codes to permanent CPT codes. The policy also adds a new HCPCS code for obecabtagene autoleucel effective April 1, 2025.

Action Required

Action needed
By January 1, 2025: Billing team must update billing software to replace expiring Category III codes (0537T-0540T) with new permanent CPT codes (38225-38228) for CAR T-cell therapy procedures. By April 1, 2025: Add new HCPCS code C9301 for obecabtagene autoleucel to billing system. Update encounter forms and charge masters with new codes to ensure proper billing.

Affected Billing Codes

38225
38226
38227
38228
C9301
J9999
Q2041
Q2042
Q2053
Q2054
Q2055
Q2056
Q2058