Medicare AdvantageCoverageMedium impact
Ocular Surface Disease Diagnosis and Treatments - Medicare Advantage (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Aug 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their policy for Ocular Surface Disease diagnosis and treatments, establishing new coverage criteria and procedures for dry eye disease and related conditions. The policy provides detailed guidance on diagnostic tests, treatment procedures, and medical necessity requirements for various ocular surface treatments.
Action Required
Before August 1, 2025: Billing teams must update prior authorization workflows and documentation requirements for ocular surface disease treatments. Review current procedures for dry eye disease coding to ensure compliance with new medical necessity criteria. Update billing software to reflect coverage determinations for amniotic membrane grafts, punctal plugs, and thermal pulsation treatments. Ensure providers document first-line treatment failures before proceeding with advanced therapies.