Medicare AdvantagePrior AuthHigh impact
Growth Hormone (Revised)
Humana·Pediatrics, Endocrinology, Internal Medicine·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana has revised its Growth Hormone (GH) therapy coverage policy for Medicare Advantage, effective January 1, 2021, with major updates as of August 27, 2025. The policy establishes comprehensive prior authorization requirements for 17 GH products across pediatric and adult indications, with specific diagnostic criteria, stimulation test requirements, and preferred product designation (Omnitrope). Billing teams must implement prior authorization workflows and ensure claims include required clinical documentation for diagnosis confirmation.
Action Required
REQUIREMENTS: By September 30, 2025: Billing team must immediately implement prior authorization (PA) requirement for all growth hormone HCPCS codes (J2941, J2944, J2945, J2950) for Humana Medicare Advantage plans. Update billing software to require PA submission before claim processing. Modify encounter templates and charge capture forms to prompt providers to document: (1) specific GH deficiency diagnosis and etiology; (2) GH stimulation test results with actual values and test type used; (3) baseline growth measurements, growth velocity, and bone age assessments for pediatric patients; (4) IGF-1 levels and other pituitary hormone status for adult patients; (5) confirmation that member is not severely obese or has severe respiratory impairment (if applicable). Establish verification process to confirm Omnitrope is designated as preferred product and document rationale if alternative product prescribed. Clinical staff must verify all required diagnostic criteria are met before billing team submits PA requests. Train front desk staff to alert patients that GH therapy requires pre-authorization and may have extended approval timelines. Failure to obtain prior authorization will result in claim denials and member balance issues.