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Genetic and Coagulation Testing for Noncancer Blood Disorders - Medicare Advantage (Revised)
Act
by Feb 2, 2026, billing team must
Effective date
Feb 2, 2026
Identified
Aug 12, 2026
Summary
This is a comprehensive Medicare Advantage policy update for genetic and coagulation testing in noncancer blood disorders, effective February 2, 2026. The policy establishes coverage determination criteria, identifies applicable CPT/HCPCS codes, and references multiple MAC-specific Local Coverage Determinations (LCDs) organized by geographic jurisdiction. Billing teams must align claims submission with the appropriate MAC's LCD requirements based on patient location.
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What to do
by Feb 2, 2026, billing team must · 7 steps
01Map all genetic and coagulation testing claims to the appropriate MAC jurisdiction based on patient state.
02Reference the correct MAC-specific LCD (e.g., MolDX policies for applicable regions) when validating medical necessity and billing codes for Factor V Leiden, Factor II Prothrombin, MTHFR, hemophilia, Fanconi anemia, G6PD deficiency, and hemoglobinopathy testing.
03Update billing software to route claims to the correct MAC contractor based on geographic jurisdiction listed in policy (J5, J8, J6, JK, J15, JE, JF, JH, JL, JJ, JM, JN).
04Ensure prior authorization follows the specific MAC's LCD requirements before submitting claims.
05Train coding and billing staff on which LCD applies to each state/territory served.
06Claims submitted without adherence to the appropriate MAC's LCD coverage criteria will be denied.
07Note: The full policy document (24 pages) contains specific codes in the Coverage Determination and Coding Information sections not visible in this excerpt—billing team must access the complete policy via the source URL to identify exact CPT/HCPCS codes for each test category.
Original notice
Genetic and Coagulation Testing for Noncancer Blood Disorders - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Genetic and Coagulation Testing for Noncancer Blood Disorders - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageGenetic and Coagulation Testing for Noncancer Blood Disorders - Medicare Advantage (Revised)MediumEffective Feb 2, 2026 · Medicare AdvantageBrowse every Humana change in the policy list