Medicare AdvantageCoverageMedium impact
Radiofrequency Tumor Ablation - Medicare Advantage (Revised)
Humana·Oncology, Radiation Oncology, General Surgery +3 more·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their radiofrequency tumor ablation (RFA) coverage policy, establishing specific medical necessity criteria for various tumor types including bone, hepatic, renal, lung, thyroid tumors and soft tissue sarcomas. The policy excludes coverage for breast and prostate tumors and spinal procedures.
Action Required
Before September 2, 2025: Review and update prior authorization workflows for radiofrequency tumor ablation procedures to align with new medical necessity criteria. Billing team must ensure documentation meets specific size, staging, and surgical candidacy requirements for covered indications. Update system to flag breast tumors, prostate tumors, and spinal procedures as non-covered. Train providers on new criteria including tumor size limits (typically <3-5cm) and requirement that patients not be surgical candidates.