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Cardiac Stress Testing - MEDICAID - VIRGINIA (New)
Effective date
Aug 26, 2026
Identified
Aug 25, 2026
Summary
Humana Medicaid Virginia establishes comprehensive coverage criteria for cardiac stress testing (CPT 78466, 78468, 78469 and HCPCS A9611) effective 08/26/2026. This new policy defines specific clinical indications for coverage including diagnosis of coronary artery disease, heart failure evaluation, post-intervention assessment, myocardial viability testing, oncology cardiac risk stratification, and congenital heart disease evaluation. Billing teams must verify medical necessity against these specific indications before claim submission to avoid denials.
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What to do
Action · 7 steps
01By 08/26/2026: Billing team must implement medical necessity verification for all cardiac stress testing claims under Humana Medicaid Virginia.
02Update billing system to require documentation of one or more qualifying indications from policy before claim submission: symptomatic CAD evaluation, acute/recent ACS, heart failure with reduced or preserved EF, post-PCI/CABG with recurrent symptoms, myocardial viability assessment, oncology cardiac risk stratification, chronic chest pain with documented CAD, coronary artery anomaly, cardiac arrhythmia evaluation, congenital heart disease assessment, or heart transplant vasculopathy evaluation.
03Create internal checklist or template for providers documenting the specific indication(s) that justify the test.
04Train billing and prior authorization staff to cross-reference submitted claims against the 12 covered indication categories listed in the policy.
05Implement system edits to flag claims missing documentation of medical necessity.
06Claims submitted without evidence of a covered indication will be denied.
07Note: Policy excludes coverage for patients with acute MI, high-risk unstable angina, or pregnant individuals.
Codes mentioned
784667846878469A9611
Original notice
Cardiac Stress Testing - MEDICAID - VIRGINIA (New)
mcp.humana.com · Always check the source before changing claims.
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