Medicare AdvantageCoverageMedium impact
Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)
Humana·Oncology, Genetics·Medicare Advantage
We identified it
Aug 4, 2026
Summary
This is a new Medicare Advantage policy on genetic testing for hereditary cancer that outlines coverage for germline genetic testing to identify gene variants associated with inherited cancers. The policy appears to define medical necessity and scope of covered genetic testing services, but the provided content is incomplete (cuts off mid-sentence) and lacks critical details such as specific CPT codes, prior authorization requirements, effective dates, and coverage limitations.
Action Required
URGENT: Billing team must obtain the complete policy document from Humana immediately. The provided summary is incomplete and does not contain sufficient information to implement billing changes. Contact Humana at the provided URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a59071b) to request the full policy text. Do NOT make any billing system changes until you have: (1) specific CPT/HCPCS codes for genetic testing, (2) prior authorization requirements, (3) medical necessity criteria, (4) coverage limitations, and (5) the actual effective date. Flag this policy as 'INCOMPLETE' in your tracking system pending receipt of full documentation.