Medicare AdvantageBilling CodesHigh impact
Superficial Radiation Therapy - Medicare Advantage (Revised)
Humana·Dermatology, Oncology, Radiation Oncology·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Aug 7, 2026
Summary
Humana Medicare Advantage has updated its Superficial Radiation Therapy (SRT) policy effective 08/03/2026, establishing coverage criteria for nonmelanoma skin cancer treatment and introducing four new CPT codes (77436, 77437, 77438, 77439) effective 01/01/2026. The policy covers SRT including electronic brachytherapy and image-guided SRT when medical necessity criteria from applicable Local Coverage Determinations are met, with coverage varying by Medicare Administrative Contractor jurisdiction.
Action Required
REQUIREMENTS:
By January 1, 2026: Billing team must add four new CPT codes to billing system: 77436 (planning/simulation), 77437 (superficial delivery ≤150 kV), 77438 (orthovoltage delivery >150-500 kV), and 77439 (image guidance-ultrasound add-on code). Update fee schedules and reimbursement rules for these codes in the billing software.
Before August 3, 2026: Billing team must implement jurisdiction-specific coverage criteria based on the applicable Medicare Administrative Contractor (MAC) for each member's geographic location. Configure billing system to apply correct LCD requirements:
- J5/J8 MACs (Wisconsin): Use LCD L40193/A60213
- J6/JK MACs (Illinois, Minnesota, Wisconsin, Northeast): Use LCD L40168/A60176
- J15/JK MACs (Kentucky, Ohio): Use LCD L40179/A60185
- JE/JF MACs (Western/Pacific states): Use LCD L40176/A60181
- JJ/JM MACs (Southeast): Use LCD L40189/A60211
Immediate: Providers and coders must verify patient eligibility under applicable LCD criteria before submitting claims. Medical necessity documentation must demonstrate lesion characteristics and treatment justification per applicable MAC LCD. Claims not meeting LCD requirements will be denied as not medically reasonable and necessary.
For all Medicare Advantage members: Claims for SRT (CPT 77436, 77437, 77438) must include supporting documentation of nonmelanoma skin cancer diagnosis and medical necessity per the applicable MAC's LCD. Prior authorization should be obtained when required by member's specific plan or MAC guidelines.