Medicare AdvantageCoverageHigh impact
Foot Surgical Procedures - Medicare Advantage (Revised)
Humana·Podiatry, Orthopedics, General Surgery·Medicare Advantage
Effective date
Sep 1, 2026
We identified it
Aug 29, 2026
Summary
Humana Medicare Advantage updated its coverage policy for foot surgical procedures (bunions, hallux valgus, lesser toe deformities, and other foot conditions) effective 09/01/2026. The policy establishes specific medical necessity criteria, including radiographic evidence and documented failure of conservative treatment, for procedures coded 28240, 28292, 28295-28299, and 28306. Billing teams must ensure documentation aligns with these coverage requirements to avoid claim denials.
Action Required
Before September 1, 2026: (1) Billing team must update prior authorization workflows and claims submission protocols in billing software to require documented radiographic evidence AND failure of conservative treatment for all bunion/hallux valgus surgical procedures (CPT 28240, 28292, 28295-28299, 28306). (2) Providers must be notified to include in medical records: radiographic evidence of deformity, documentation of failed conservative treatments (modified footwear, orthotics, NSAIDs, protective pads), and clinical evidence of neuroma development, limited/painful range of motion at first MTP joint, or painful prominence of dorsiflexed second toe. (3) Update encounter forms and EMR templates to include checklist for required documentation elements. (4) Clinical staff should review policy to understand specific criteria for lesser toe deformities, hallux limitus, hallux rigidus, Lisfranc injuries, and MTP joint replacements. (5) Compliance: Claims submitted without required documentation will be denied by Humana Medicare Advantage.