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HumanaMedicare Advantage · Coverage · Medicare Advantage · Gastroenterology, General Surgery, Internal Medicine +2 moreMedium impact

Colorectal Cancer Screening - Medicare Advantage (Revised)

Act
by Aug 31, 2026
Effective date
Aug 31, 2026
Identified
Sep 1, 2026

Summary

This is a comprehensive Medicare Advantage colorectal cancer screening policy (HUM-1054-011) that became effective 08/31/2026, establishing coverage parameters for various CRC screening methods including endoscopic procedures, laboratory tests (SEPT9, blood biomarkers, stool-based tests), radiologic imaging, and urine-based testing. The policy applies Humana's coverage determinations aligned with CMS National and Local Coverage Determinations across all MAC jurisdictions.

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What to do

by Aug 31, 2026 · 6 steps
01Billing team must ensure claims processing systems reflect this updated Humana Medicare Advantage CRC screening policy.
02Verify that SEPT9 genetic tests (CPT 81327) are processed as statutorily excluded and are not billed to Medicare Advantage members.
03Confirm that the applicable MAC LCDs for your geographic jurisdiction are loaded in the billing system—reference the policy's MAC/jurisdiction table to identify your specific MAC (J5, J6, J8, J15, JE, JF, JH, JJ, JL, JM, or JN).
04Update internal policy documentation and provider communications to reflect approved CRC screening modalities (colonoscopy, sigmoidoscopy, MT-sDNA, FOBT/FIT, CTC, MR colonography, and qualifying biomarker panels).
05Train billing and authorization staff on coverage limitations and related policies (Capsule Endoscopy, Genetic Testing for Hereditary Colorectal Cancer, Liquid Biopsy).
06Establish process to cross-reference member coverage documents, as individual plans may deviate from this policy.
If missed: Failure to comply may result in inappropriate claim denials or rejections for excluded services.

Codes mentioned

81327

Original notice

Colorectal Cancer Screening - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Colorectal Cancer Screening - Medicare Advantage (Revised)MediumEffective Jun 8, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

Related policy hubs

Humana policiesGastroenterologyGeneral SurgeryInternal MedicineRadiologyPathologyCode 81327

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