Medicare AdvantageCoverageMedium impact
Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)
Humana·Oncology, Genetics, OB-GYN +2 more·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
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.
Action Required
By September 2, 2025: Billing team must review current genetic testing procedures to ensure compliance with updated Humana Medicare Advantage criteria. Verify that genetic testing orders meet the medical necessity requirements outlined in applicable LCD guidelines for each MAC jurisdiction. Ensure providers document appropriate clinical indications and that tests are FDA-approved or listed in the DEX registry where required.