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Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
Act
by Aug 3, 2026
Effective date
Aug 3, 2026
Identified
Jul 30, 2026
Summary
This is a comprehensive Medicare Advantage policy for Benign Prostatic Hyperplasia (BPH) treatments that became effective on August 3, 2026. The policy outlines coverage for multiple surgical and minimally invasive treatment modalities including TURP, laser therapies, temporary implanted devices, and stents, with specific coverage determinations varying by MAC jurisdiction. Billing teams must verify applicable MAC-specific LCDs and NCDs by geographic location before processing BPH treatment claims.
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What to do
by Aug 3, 2026 · 6 steps
01Billing team must obtain and integrate all applicable MAC-specific Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) into the billing system based on patient geographic location.
02Cross-reference the MAC jurisdiction table provided (J5, J6, J8, J15, JE, JF, JH, JL, JJ, JN) with the applicable states/territories to determine correct coverage rules before processing claims.
03Update encounter forms and prior authorization workflows to require documentation of medical necessity per MAC guidelines.
04Medical coders must verify that submitted claims align with the specific LCD requirements for the patient's MAC jurisdiction (e.g., L38682, L38367, L38378, L38705, L38712, L38549, L38726 and corresponding LCAs).
05Failure to apply correct MAC-specific rules will result in claim denials or recoupment.
06Notify providers that TUMT and TUNA are considered legacy technologies and may have restricted coverage under current AUA guidelines.
Original notice
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)MediumEffective Sep 1, 2026 · Medicare AdvantageBenign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)HighEffective Sep 1, 2026 · Medicare AdvantageBenign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)MediumEffective Jun 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list
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