Medicare AdvantagePrior AuthLow impact
Chenodal™ (chenodiol) (Revised)
Humana·Gastroenterology, General Surgery, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2015
We identified it
Jun 25, 2026
Summary
This is a revision to Humana's Chenodal (chenodiol) prior authorization policy for Medicare Advantage members. The policy requires prior authorization for Chenodal tablets used to treat radiolucent gallstones, with three mandatory approval criteria: diagnosis of radiolucent gallstones in well-opacifying gallbladders, patient ineligibility for laparoscopic cholecystectomy, and prior treatment/contraindication/intolerance to ursodiol. Pre-existing liver disease is an exclusion criterion.
Action Required
Billing team should review this policy revision to ensure prior authorization procedures for Chenodal are up-to-date. When processing Chenodal claims for Humana Medicare Advantage members, verify that: (1) prior authorization has been obtained before claim submission, (2) member meets all three approval criteria (radiolucent gallstones diagnosis, surgical ineligibility, prior ursodiol treatment/contraindication/intolerance), and (3) member does not have pre-existing liver disease documented. Update internal clinical guidelines or prior authorization checklists if Chenodal is regularly prescribed at your practice. No billing code changes are required. Note: The policy revision date is August 27, 2025, but the effective date remains January 1, 2015, indicating this is a routine policy update rather than a new coverage determination.