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HumanaMedicare Advantage · Coverage · Medicare Advantage · IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, NY, ME, MA, NH, RI, VT, KY, OH, CA, HI, NV, AS, GU, MP, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, NM, OK, TX, LA, MS, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR, VI · Oncology, Hematology, Pulmonology +2 moreMedium impact

Liquid Biopsy - Medicare Advantage (Revised)

Act
by Aug 3, 2026
Effective date
Aug 3, 2026
Identified
Aug 4, 2026

Summary

Humana Medicare Advantage has updated its Liquid Biopsy coverage policy (Policy HUM-1151-014), effective 08/03/2026. This policy establishes coverage criteria for liquid biopsy tests (blood-based biomarker analysis for cancer detection and treatment monitoring) across multiple jurisdictions under Medicare Administrative Contractors. The policy requires medical necessity documentation and adherence to MAC-specific Local Coverage Determinations, with coverage determined through analytical/clinical validity standards and DEX Registry evaluation where CMS guidance is absent.

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What to do

by Aug 3, 2026 · 8 steps
01Billing team must review and update billing workflows to align with this policy revision.
02Verify which MAC jurisdiction(s) your practice operates under (J5, J8, J6, JK, J15, JE, JF, JH, JL, JJ, JM, or JN as listed in policy) and obtain the corresponding LCD/LCA documents for liquid biopsy tests.
03Update claim submission guidelines to include proper medical necessity documentation for all liquid biopsy tests (circulating tumor DNA, circulating tumor cells, and biomarker analyses).
04Establish prior authorization protocols where required by the applicable MAC jurisdiction.
05Train billing and clinical staff on coverage criteria including analytical validity, clinical validity, and clinical utility requirements.
06Update EMR/billing system to flag liquid biopsy claims for verification against MAC-specific coverage limitations.
07Do NOT process liquid biopsy claims without confirming coverage under the applicable regional MAC LCD/LCA.
08Non-compliant claims will be denied.

Original notice

Liquid Biopsy - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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