MedicaidCoverageHigh impact
Cardiac Stress Testing - MEDICAID - FLORIDA (New)
Humana·FL · Cardiology, Nuclear Medicine, Radiology +1 more·Medicaid
Effective date
Sep 2, 2026
We identified it
Sep 2, 2026
Summary
Humana has issued a new Medicaid cardiac stress testing coverage policy for Florida (effective 09/02/2026) that establishes comprehensive medical necessity criteria for cardiac stress testing procedures. The policy covers CPT codes 78466, 78468, 78469, and HCPCS code A9611 (Flurpiridaz F-18) for multiple cardiac indications including CAD diagnosis, heart failure evaluation, post-intervention assessment, and oncology risk stratification. Billing teams must update their authorization and coding systems to align with these specific coverage indications to avoid claim denials.
Action Required
By September 2, 2026: Billing and authorization teams must (1) Update prior authorization workflows in billing system to require medical necessity documentation matching the 12 coverage indications listed in the policy (CAD diagnosis, heart failure, post-PCI/CABG assessment, viability assessment, oncology risk stratification, chronic chest pain, coronary anomaly, dyspnea evaluation, tetralogy of Fallot/pulmonary stenosis, transplant vasculopathy, infiltrative cardiomyopathy, and complex congenital heart disease); (2) Configure billing software to accept CPT 78466, 78468, 78469 and HCPCS A9611 claims only when paired with approved clinical indicators; (3) Update encounter templates and provider documentation requirements to capture applicable indications; (4) Train providers and billing staff on exclusion criteria (acute MI, high-risk unstable angina, pregnancy); (5) Flag any claims lacking matching medical necessity documentation for denial. Failure to implement these requirements will result in increased claim denials for cardiac stress testing under Humana Medicaid Florida plans.