Humana·AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, FL, PR, VI, KY, OH, IA, KS, MO, NE, IN, MI, CA, HI, NV, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AL, GA, TN, NC, SC, VA, WV · Cardiology, Internal Medicine, Critical Care·Medicare Advantage
Effective date
Sep 1, 2026
We identified it
Aug 28, 2026
Days to comply
—
Summary
Humana Medicare Advantage has revised its Ambulatory Cardiac Monitoring Devices policy effective September 1, 2026. The policy provides updated coverage guidance for various cardiac monitoring technologies (Holter monitors, patch recorders, external loop monitors, implantable loop recorders, and mobile cardiac outpatient telemetry) with MAC-specific coverage determinations by geographic jurisdiction. The policy document appears incomplete but establishes that medical necessity determinations will follow applicable NCDs and LCDs based on the member's jurisdiction.
Action Required
Action needed
By August 1, 2026: Billing team must review the complete policy document (this excerpt is incomplete at page 5 of 13) and identify all applicable MAC LCDs for your service area jurisdiction. Update billing system rules to require prior authorization and medical necessity documentation for CPT codes 93224-93226 (Holter monitors) and 93241-93248 (long-term continuous cardiac rhythm monitors) according to the specific LCD requirements for your geographic MAC jurisdiction. Verify which MAC applies to your practice location using the MAC jurisdiction table provided. Obtain and implement the detailed coverage criteria from applicable LCDs (e.g., L39490, L39492, L40244, L40255, L40257) before the September 1, 2026 effective date. Failure to apply correct jurisdiction-specific LCD requirements will result in claim denials. Flag to cardiology and internal medicine providers that cardiac monitoring device ordering must include specific medical necessity justification tied to the LCD requirements for your region.