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Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)
Effective date
Aug 10, 2026
Identified
Aug 8, 2026
Summary
Humana's revised Medicare Advantage coverage policy for noninvasive liver fibrosis tests (HUM-1171-008) took effect August 10, 2026, after its original January 2, 2024 effective date and May 12, 2026 review. It states that FIB-4 testing (CPT 81599) is considered reasonable and necessary for detecting and staging hepatic fibrosis, and sets criteria for magnetic resonance elastography (CPT 76391), though the excerpt cuts off before those criteria are complete.
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What to do
Action · 4 steps
01Already effective August 10, 2026 for Humana Medicare Advantage members: Hepatology, gastroenterology and primary care ordering staff should document the reason for FIB-4 testing (CPT 81599) for detecting or staging hepatic fibrosis, because the policy considers it reasonable and necessary for that use.
02For magnetic resonance elastography (CPT 76391), billing team should pull the full HUM-1171-008 policy and confirm the complete criteria before billing, since the excerpt stops partway through the MRE criteria, and document each criterion in the chart.
03Billing team should also check the Medicare Administrative Contractor coverage for biomarker testing in metabolic dysfunction-associated steatotic liver disease (MolDX) for the practice's jurisdiction, because Humana applies the MAC's local coverage determination to Part A and Part B services in that jurisdiction.
04Update the charge entry notes and tell providers and front desk staff about the documentation needed.
Codes mentioned
8159976391
Original notice
Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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