Medicare AdvantageCoverageMedium impact
Prostatectomy - Medicare Advantage (Revised)
Humana·Urology, Oncology·Medicare Advantage
We identified it
Jul 2, 2026
Summary
This is a Medicare Advantage policy update regarding prostatectomy procedures. The policy defines prostatectomy as removal of the prostate gland with or without nerve sparing, including surrounding tissues, seminal vesicles, and nearby lymph nodes. However, the provided content is summary-only and lacks specific billing codes, coverage rules, prior authorization requirements, or effective dates needed for billing implementation.
Action Required
Immediately: Billing team must obtain the FULL policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5699c1) to extract complete details including: specific CPT codes for prostatectomy variants, prior authorization requirements, coverage limitations, and effective date. Do not implement any billing changes based on this summary alone. Once full policy is retrieved, update billing system rules, encounter forms, and provider alerts as needed. Flag this policy for follow-up within 24 hours to prevent claim denials.