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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, Cardiothoracic Surgery, Internal Medicine +1 moreHigh impact

Percutaneous Coronary Intervention - Medicare Advantage (Revised)

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

Summary

Humana Medicare Advantage updated its Percutaneous Coronary Intervention (PCI) coverage policy effective August 3, 2026, clarifying medical necessity criteria for PCI procedures and adding specific coverage requirements for Coronary Intravascular Lithotripsy (IVL) when treating severely calcified coronary stenosis. The policy applies MAC-specific LCDs across multiple jurisdictions and establishes that PCI is covered for acute coronary syndrome, chest pain despite optimal medical therapy, in-stent restenosis, recent STEMI, and silent ischemia.

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What to do

by Aug 3, 2026 · 8 steps
01Billing team must update all PCI billing protocols to align with this revised Medicare Advantage policy.
02In billing software, configure mandatory medical necessity documentation requirements for CPT codes 92920, 92924, 92928, 92930, 92933, 92937, 92941, 92943, 92945, and HCPCS codes C9600-C9608.
03Ensure all PCI claims include documentation supporting one of the five covered indications: acute coronary syndrome, chest pain despite optimal medical therapy, in-stent restenosis with symptoms/ischemia, recent STEMI (within 45 days) with non-infarct artery involvement, or silent ischemia.
04For Coronary IVL procedures (CPT 92972, HCPCS C1761, C7571), update templates to require documentation of hemodynamically significant, severely calcified coronary stenosis and vessel preparation purpose prior to PCI.
05Verify the applicable MAC LCD for your jurisdiction (J5, J8, J6, JK, J15) and cross-reference with CMS Medicare Coverage Database.
06Training: Instruct providers and prior authorization staff on the five specific indications; claims lacking documented medical necessity will be denied.
07Review all pending PCI claims to ensure compliance before effective date.
08Update encounter forms and EMR templates to prompt documentation of calcification status for IVL claims.

Codes mentioned

929209292492928929309293392937929419294392945C9600C9601C9602C9603C9604C9605C9607C960892972C1761C7571

Original notice

Percutaneous Coronary Intervention - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Percutaneous Coronary Intervention - Medicare Advantage (Revised)HighEffective Feb 2, 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 changesCardiologyCardiothoracic SurgeryInternal MedicineCritical CareCode 92920Code 92924Code 92928Code 92930Code 92933Code 92937Code 92941Code 92943Code 92945Code C9600Code C9601Code C9602Code C9603Code C9604Code C9605Code C9607Code C9608Code 92972Code C1761Code C7571

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