← Back to list
Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)
Act
by Aug 3, 2026
Effective date
Aug 3, 2026
Identified
Aug 4, 2026
Summary
This is a comprehensive Medicare Advantage policy on genetic testing for hereditary cancer syndromes, effective August 3, 2026. The policy establishes coverage guidelines for germline genetic testing across multiple cancer types (melanoma, gastric cancer, neuroendocrine tumors, renal cell carcinoma, and others) and references specific MAC-based Local Coverage Determinations (LCDs) that vary by geographic jurisdiction. Billing teams must verify applicable MAC jurisdiction and LCD requirements before processing claims.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
by Aug 3, 2026 · 3 steps
01Billing team must (1) map practice locations to applicable Medicare Administrative Contractor (MAC) jurisdictions using the policy's geographic reference table (J5, J8, J6, JK, J15, KY/OH, JE, JF, JH, JL, JJ, JM, JN); (2) obtain and implement the corresponding MolDX and/or molecular pathology LCDs for each jurisdiction (e.g., L39040, L36807, L38429 for J5/J8 MAC); (3) update billing system rules to require prior authorization verification against the applicable LCD before submitting genetic testing claims; (4) train coding staff on the specific coverage limitations and medical necessity documentation requirements outlined in each MAC's LCD; (5) establish internal process to route genetic testing claims to the correct MAC based on service location.
02Failure to apply correct MAC-specific LCD requirements will result in claim denials and payment delays.
03Reference the related policies listed (Comprehensive Genomic Profiling, Hereditary Breast/Ovarian/Pancreatic/Prostate Cancer, Hereditary Colorectal/Uterine Cancer, and Single Gene/Molecular Biomarker Testing) for additional coverage context.
Original notice
Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageGenetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)MediumEffective Oct 1, 2026 · Medicare AdvantageGenetic Testing for Hereditary Cardiovascular Disease - Medicare Advantage (Revised)HighEffective Jul 1, 2026 · Medicare AdvantageGenetic Testing for Hereditary Cancer - Medicare Advantage (Revised)MediumEffective May 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list
Related policy hubs
Humana policiesIA policy changesKS policy changesMO policy changesNE policy changesIN policy changesMI policy changesIL policy changesMN policy changesWI policy changesCT policy changesNY policy changesME policy changesMA policy changesNH policy changesRI policy changesVT policy changesKY policy changesOH policy changesCA policy changesHI policy changesNV policy changesAK policy changesAZ policy changesID policy changesMT policy changesND policy changesOR policy changesSD policy changesUT policy changesWA policy changesWY policy changesAR policy changesCO policy changesNM policy changesOK policy changesTX policy changesLA policy changesMS policy changesDE policy changesDC policy changesMD policy changesNJ policy changesPA policy changesAL policy changesGA policy changesTN policy changesNC policy changesSC policy changesVA policy changesWV policy changesFL policy changesPR policy changesOncologyGeneticsPathology