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Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)
Effective date
Apr 1, 2026
Identified
Aug 25, 2026
Summary
Humana Medicare Advantage updates coverage criteria for hyperthermia and ultrasound-based ablative cancer treatments effective April 1, 2026. The policy establishes specific medical necessity requirements for HIPEC (CPT 96547, 96548), ILI/ILP (CPT 36823), laser therapy (CPT 0970T, 0971T), and HIFU (CPT 55880) procedures. Billing teams must verify patient eligibility against these criteria and ensure proper documentation before claim submission.
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What to do
Action · 8 steps
01Before April 1, 2026: Billing team must implement coverage verification logic in claims system for the six affected CPT codes.
02For CPT 96547/96548 (HIPEC): Verify procedure is combined with cytoreductive surgery AND one of three conditions: gastric cancer without macroscopic peritoneal metastases, peritoneal carcinomatosis without extraperitoneal metastases, or pseudomyxoma peritonei.
03For CPT 36823 (ILI/ILP): Verify diagnosis is stage III in-transit melanoma.
04For CPT 0970T/0971T (laser therapy): Verify patient is enrolled in approved IDE study for breast tumors.
05For CPT 55880 (HIFU): Verify patient meets salvage local therapy candidacy criteria (criteria appears incomplete in source document).
06Update encounter forms and clinical documentation templates to capture required medical necessity elements.
07Train billing and clinical staff on new requirements.
08Configure system edits to flag claims lacking required documentation.
If missed: Failure to verify criteria will result in claim denials from Humana Medicare Advantage plans.
Codes mentioned
96547965483682355880
Original notice
Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)MediumEffective Apr 1, 2026 · Medicare AdvantageHyperthermia and Ultrasound Based Ablative Cancer Treatments - Medicare Advantage (Revised)MediumEffective Oct 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list