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Functional Electrical Stimulators (Non-Pain) - Medicare Advantage (Revised)
Act
by Aug 3, 2026
Effective date
Aug 3, 2026
Identified
Aug 4, 2026
Summary
Humana Medicare Advantage revised its Functional Electrical Stimulators (Non-Pain) policy effective 08/03/2026, establishing coverage criteria for phrenic nerve stimulator adjustments, repairs, replacements, and removals. The policy clarifies that these procedures are medically reasonable and necessary only when the device remains medically necessary or when complications warrant intervention. Billing teams must ensure claims for phrenic nerve procedures (33278-33280, 33281, 33287, 33288) include documentation of medical necessity.
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What to do
by Aug 3, 2026 · 6 steps
01Billing team must update claim review processes and prior authorization workflows to require documentation supporting medical necessity for all phrenic nerve stimulator procedures (CPT 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 64575, 93150, 93151, 93152, 93153).
02For adjustments/repositioning, repair, or replacement claims (33281, 33287, 33288), require provider documentation confirming the device remains medically necessary.
03For removal claims (33278, 33279, 33280), require documentation that either the medical condition no longer necessitates the device or complications/adverse changes (such as infection, electrode failure, or undesirable stimulation) warrant removal.
04Update billing software denial rules to reject claims lacking this documentation.
05Train billing staff and providers on new documentation requirements to prevent claim denials.
06Reference CMS NCD 160.19 when adjudicating claims.
Codes mentioned
33276332773327833279332803328133287332886457593150931519315293153
Original notice
Functional Electrical Stimulators (Non-Pain) - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
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