Medicare AdvantagePrior AuthMedium impact
Sinuva® (mometasone furoate) sinus implant (Revised)
Humana·FL, KY, SC, VA · ENT (Ear, Nose & Throat)·Medicaid
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Sinuva® (mometasone furoate) sinus implant prior authorization policy effective June 24, 2026, covering Medicare and Medicaid plans in Florida, Kentucky, South Carolina, and Virginia. The policy requires prior authorization for all Sinuva implant requests and mandates that patients meet two criteria: diagnosed chronic rhinosinusitis with nasal polyps (CRSwNP) and age 18 or older. Billing teams must implement prior authorization workflows immediately for these specific state Medicaid programs and Medicare plans to prevent claim denials.
Action Required
By June 24, 2026: Billing team must implement prior authorization requirement for all Sinuva® sinus implant claims submitted to Humana Medicare, Medicaid-Florida, Medicaid-Kentucky, Medicaid-South Carolina, and Medicaid-Virginia plans. Update billing system to flag Sinuva claims for prior authorization submission before claim processing. Providers must document that patients: (1) have confirmed diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP), and (2) are age 18 or older. Add verification checklist to encounter forms or EMR templates for these plan types and states. Route all Sinuva requests through Humana's PAL (Preauthorization and Notification List) portal at www.humana.com/PAL to obtain approval codes before claim submission. Failure to obtain prior authorization will result in claim denials. Notify ENT providers and surgical center staff in FL, KY, SC, and VA of new requirement.