MedicaidCoverageHigh impact
Cardiac Stress Testing - MEDICAID - MICHIGAN (New)
Humana·MI · Cardiology, Nuclear Medicine, Radiology +3 more·Medicaid
Effective date
Aug 26, 2026
We identified it
Aug 25, 2026
Summary
Humana Medicaid Michigan has issued a new cardiac stress testing coverage policy (HUM-MI-2658-000) effective 08/26/2026 that establishes comprehensive medical necessity criteria for stress testing procedures. The policy covers CPT codes 78466, 78468, 78469 and HCPCS code A9611 (Flurpiridaz F-18) for specific cardiac indications including CAD diagnosis, heart failure evaluation, post-intervention assessment, viability testing, oncology risk stratification, and congenital heart disease evaluation. Billing teams must verify claims meet one of the listed clinical indications to ensure coverage and avoid denials.
Action Required
By 08/26/2026, billing team must: (1) Update billing software to recognize CPT codes 78466, 78468, 78469 and HCPCS code A9611 as covered services under this Humana Medicaid Michigan policy only when accompanied by one of the specified medical necessity indications; (2) Create internal validation rules to require providers to document which covered indication from the policy supports each stress testing request; (3) Update encounter forms and EMR templates with the approved indications checklist to ensure providers select from: CAD diagnosis/risk stratification, heart failure evaluation, post-PCI/CABG assessment, myocardial viability testing, oncologic therapy risk assessment, chronic chest pain evaluation, coronary artery anomaly pretreatment planning, cardiac arrhythmia/dyspnea assessment, or congenital heart disease evaluation; (4) Brief billing and authorization staff on exclusion criteria (acute MI, high-risk unstable angina, pregnancy); (5) Flag any claims lacking documented medical necessity for denial or prior authorization review. Failure to document qualifying indication will result in claim denials from Humana Medicaid Michigan.