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Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)
Act
by Sep 2, 2025
Effective date
Sep 2, 2025
Identified
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their genetic testing policy for hereditary breast, ovarian, pancreatic and prostate cancer effective September 2, 2025. The policy establishes coverage criteria following CMS guidelines and MolDX requirements for molecular diagnostic tests and laboratory-developed tests.
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What to do
by Sep 2, 2025 · 3 steps
01Billing team must review current genetic testing procedures to ensure compliance with updated Humana Medicare Advantage criteria.
02Verify that genetic testing orders meet the medical necessity requirements outlined in applicable LCD guidelines for each MAC jurisdiction.
03Ensure providers document appropriate clinical indications and that tests are FDA-approved or listed in the DEX registry where required.
Original notice
Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageGenetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)MediumEffective Oct 1, 2026 · Medicare AdvantageGenetic Testing for Hematologic Malignancies and Suspected Myeloid Disorders - Medicare Advantage (Revised)HighEffective Sep 1, 2026 · Medicare AdvantageGenetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)HighEffective Aug 3, 2026 · Medicare AdvantageBrowse every Humana change in the policy list