Medicare AdvantageCoverageMedium impact
Minimal Residual Disease Testing - Medicare Advantage (Revised)
Humana·Hematology, Oncology, Radiation Oncology·Medicare Advantage
We identified it
Jul 2, 2026
Summary
This Medicare Advantage policy establishes coverage guidelines for Minimal Residual Disease (MRD) testing in hematologic malignancies and solid tumors. The policy defines MRD testing as a method to determine prognosis, guide treatment decisions, and monitor therapy response, with specific tests listed including ClonoSEQ, Guardant360 Response, Guardant Reveal, NavDx, OncoDetect, Pathlight, RaDar, and Signatera.
Action Required
Immediately: Billing and clinical teams must review this new Medicare Advantage MRD testing policy. Obtain the complete policy document (not just summary) from the Humana source URL to determine: (1) specific coverage criteria and medical necessity requirements, (2) prior authorization requirements, (3) applicable CPT/HCPCS codes for MRD tests, and (4) any patient cost-sharing details. Until the full policy is reviewed, flag all MRD test claims for manual review to prevent denials. Update billing software rules and provider education materials once complete policy details are confirmed. This is a 1-day-old policy requiring urgent attention to ensure compliant billing.