Medicare AdvantageCoverageHigh impact
Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage (Revised)
Humana·Orthopedics, Neurosurgery, General Surgery·Medicare Advantage
Effective date
Sep 1, 2026
We identified it
Aug 29, 2026
Summary
Effective September 1, 2026, Humana Medicare Advantage will NOT cover Dynamic Spinal Stabilization (DSS) procedures or Vertebral Body Tethering (VBT) procedures for any indication. All claims for these procedures using the listed CPT and Category III codes will be denied as not medically reasonable and necessary. The policy cites insufficient evidence and lack of long-term outcome data to support coverage.
Action Required
By August 31, 2026: Billing team must update all billing system rules, claim scrubbers, and authorization workflows to DENY all claims submitted with CPT codes 22836, 22837, 22838, 22867, 22868, 22869, 22899 and Category III codes 0656T, 0657T, 0790T for Humana Medicare Advantage members. Clinical staff must be notified that NO indications exist for coverage—prior authorization requests for DSS or VBT procedures should be proactively DENIED before scheduling. Update denial reason in system to: 'Service not covered under Humana Medicare Advantage policy HUM-1072-007. Dynamic spinal stabilization and vertebral body tethering are not medically reasonable and necessary per policy effective 09/01/2026.' Communicate to all orthopedic and spine surgery providers in network that these procedures are non-covered effective immediately. Claims submitted without proper denial may result in improper payments that Humana may pursue for recoupment.