Medicare AdvantageCoverageMedium impact
Molecular Markers in Fine Needle Aspirates of Thyroid Nodules - Medicare Advantage (Revised)
Humana·Endocrinology, General Surgery, Oncology +1 more·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its policy for molecular markers in fine needle aspirates of thyroid nodules, effective September 2, 2025. The policy establishes coverage criteria for molecular diagnostic tests like Afirma Genomic Sequencing Classifier used to evaluate indeterminate thyroid nodules when cytopathology cannot determine if nodules are malignant or benign.
Action Required
Before September 2, 2025: Billing team must review and understand coverage requirements for thyroid nodule molecular testing under Humana Medicare Advantage plans. Ensure documentation supports medical necessity criteria and that tests are ordered by treating physicians for management of specific medical problems. Verify applicable LCD/LCA requirements based on geographic jurisdiction as coverage varies by Medicare Administrative Contractor region.