Medicare AdvantageCoverageHigh impact
Upper and Lower Extremity Magnetic Resonance Angiography/Venography - Medicare Advantage (Revised)
Humana·Radiology, Vascular Surgery, Cardiology·Medicare Advantage
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Humana Medicare Advantage has revised its coverage policy for Upper and Lower Extremity MRA/MRV (effective 07/01/2026) to establish specific medical necessity criteria for when these imaging studies are covered. The policy clarifies coverage for upper extremities (previously lacking detailed guidance) and lower extremities across multiple clinical scenarios including ischemia, hemodialysis access, trauma, vascular disease, and vasculitis. Billing teams must ensure prior authorization requests and claims documentation align with these newly defined criteria.
Action Required
By June 1, 2026: Billing team must update prior authorization templates and claim submission procedures to require supporting clinical documentation demonstrating medical necessity per the new criteria. Specifically: (1) For upper extremities MRA/MRV (C8934, C8935, C8936), ensure claims include documentation of one of the approved indications (ischemia with ultrasound inconclusive, hemodialysis access evaluation, pre/post-operative evaluation, thromboembolic disease, trauma, vascular disease, vascular masses, or vasculitis). (2) Review all standing orders and referral patterns with vascular surgeons, interventional radiologists, and cardiologists to identify cases requiring updated documentation. (3) Update claim scrubbing rules in billing software to flag C8934/C8935/C8936 claims lacking documented medical necessity criteria. (4) Train coding staff and clinical liaisons on the specific criteria hierarchy (e.g., ultrasound must be inconclusive before MRA/MRV approval in most scenarios). (5) Communicate requirements to providers via bulletin. Effective 07/01/2026, claims not meeting these criteria will be denied by Humana Medicare Advantage plans.