Medicare AdvantageCoverageMedium impact
Advanced Imaging of the Head and Neck - Medicare Advantage (Revised)
Humana·Radiology, Neurology, Neurosurgery +3 more·Medicare Advantage
Effective date
Sep 1, 2026
We identified it
Aug 28, 2026
Summary
Humana Medicare Advantage updated its coverage policy for advanced head and neck imaging (MRA and MRI) effective 09/01/2026. The policy clarifies medical necessity criteria for MRA procedures across multiple MAC jurisdictions and establishes specific high-risk screening indications for intracranial aneurysm MRA based on genetic conditions and family history. Billing teams must verify patient meets documented clinical criteria before submitting claims for these imaging codes.
Action Required
By August 15, 2026: Billing team must update claims submission protocols to require documented medical necessity for MRA codes (70544-70549) and MRI code (70543). Specifically: (1) For MRA claims, verify documentation includes one of the covered indications from LCD L33633 or confirm high-risk aneurysm screening criteria are met (ADPKD, fibromuscular dysplasia, MOPD, Type IV Ehlers-Danlos, OR two+ first-degree family members with aneurysm/SAH history). (2) For MRI orbit/face/neck (70543), verify documentation aligns with LCD L34425 criteria. (3) Update billing software rules to flag claims missing required clinical indicators for provider review before submission. (4) Provider education: Distribute summary to ordering physicians clarifying which patient populations qualify for coverage. Claims submitted without documented qualifying criteria will be denied as not medically necessary.