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HumanaMedicare Advantage · Coverage · Medicare Advantage · IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH · Cardiology, Internal Medicine, Critical CareHigh impact

Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)

Act
by Jul 15, 2026
Effective date
Aug 3, 2026
Identified
Jul 30, 2026

Summary

Humana Medicare Advantage has updated its cardiac catheterization and coronary angiography coverage policy (Policy HUM-1034-008), effective 08/03/2026. The policy establishes specific medical necessity criteria for coronary/bypass angiography procedures, requiring documented moderate to severe ischemia confirmed by nuclear imaging, echocardiography, cardiac MRI, or exercise testing. Billing teams must verify these criteria are met and documented before submitting claims to avoid denials.

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What to do

by Jul 15, 2026 · 9 steps
01Billing team must implement claims edits to require documentation of ischemia confirmation for CPT codes 93454-93461 submitted under Medicare Advantage plans.
02Update billing system to flag claims lacking one of the following.
03Nuclear perfusion SPECT/PET with ≥10% ischemic myocardium.
04Echocardiogram with ≥3/16 segments with stress-induced severe hypokinesis/akinesis or wall motion index >1.1.
05Cardiac MRI perfusion with ≥12% ischemia and/or ≥3/16 wall motion segments.
06Exercise ECG test meeting specific ST-segment criteria.
07Educate providers and documentation staff that all cardiac catheterization/angiography requests must include supporting diagnostic test results.
08Claims without proper documentation will be denied as not medically necessary.
09Update pre-authorization templates to require ischemia confirmation documentation.

Codes mentioned

9345493455934569345793458934599346093461

Original notice

Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

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Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)MediumEffective Apr 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

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Humana policiesIA policy changesKS policy changesMO policy changesNE policy changesIN policy changesMI policy changesIL policy changesMN policy changesWI policy changesCT policy changesMA policy changesME policy changesNH policy changesNY policy changesRI policy changesVT policy changesKY policy changesOH policy changesCardiologyInternal MedicineCritical CareCode 93454Code 93455Code 93456Code 93457Code 93458Code 93459Code 93460Code 93461

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