Medicare AdvantageCoverageMedium impact
Amtagvi (lifileucel) - Medicare Advantage (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Aug 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new coverage policy for Amtagvi (lifileucel), a specialized cancer immunotherapy for advanced melanoma. This treatment requires prior authorization through Humana's Corporate Transplant Department and has strict eligibility criteria including prior failed treatments with PD-1 inhibitors and BRAF inhibitors when applicable.
Action Required
By August 1, 2025: Billing team must establish workflow for Amtagvi (lifileucel) prior authorization requests through Humana's Corporate Transplant Department (1-866-421-5663, transplant@humana.com). Update billing system to flag codes C9399, J3490, J3590, XW033L7, and XW043L7 for prior auth requirement. Providers must verify patient meets all eligibility criteria including age 18+, unresectable/metastatic melanoma, and prior treatment failures before submitting requests.