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Genetic Testing for Hematologic Malignancies and Suspected Myeloid Disorders - Medicare Advantage (Revised)
Act
by Aug 15, 2026
Effective date
Sep 1, 2026
Identified
Aug 29, 2026
Summary
Humana Medicare Advantage updated its genetic testing policy for hematologic malignancies and myeloid disorders effective 09/01/2026. This comprehensive policy establishes coverage for comprehensive genomic profiling, multigene panels, targeted panels, lymphoid NGS panels, and specific single-gene tests (including JAK2 V617F, FLT3, NPM1, TP53, IDH1/IDH2, and others) when medically necessary for diagnosis, rule-out, or monitoring of cancer. The policy references multiple MAC-specific LCDs and MolDX guidance documents that must be applied based on geographic jurisdiction.
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What to do
by Aug 15, 2026 · 9 steps
01Billing team must identify which Medicare Administrative Contractor (MAC) jurisdiction applies to your practice location and obtain the corresponding LCD documents referenced in the policy (MolDX panels, NCD 90.2, and jurisdiction-specific LCAs).
02Update billing system prior authorization rules, billing software templates, and claim submission protocols to align with the specific MAC's requirements for genetic testing.
03Map current genetic testing procedures to appropriate CPT/HCPCS codes per the referenced MolDX billing and coding guidance.
04Train providers and front-desk staff on required documentation for medical necessity (disease symptoms, diagnosis/rule-out indication, or monitoring of known cancer).
05Before 09/01/2026: Test billing system changes in sandbox environment.
06Verify that claims for comprehensive genomic profiling (e.g., FoundationOne Heme, Neogenomics, Tempus xT Heme), multigene panels, and single-gene tests (JAK2 V617F, FLT3, NPM1, TP53, IDH1, IDH2, ASXL1, BTK, CCND1, CEBPA, CSF3R, CXCR4, FGFR1, KIT, KMT2A, MYD88, NRAS, PDGFRA, PLCG2, RUNX1, SF3B1, SRSF2, U2AF1, and others) will route to correct MAC LCD.
07Effective 09/01/2026: Begin enforcing new policy requirements.
08Claims submitted without proper documentation of medical necessity or that do not comply with MAC-specific LCD requirements will be denied.
09Identify your practice's MAC jurisdiction from the geographic table in the policy and request the applicable LCD documents immediately.
Original notice
Genetic Testing for Hematologic Malignancies and Suspected Myeloid Disorders - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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