← Back to list
Molecular Markers in Fine Needle Aspirates of Thyroid Nodules - Medicare Advantage (Revised)
Act
by Sep 10, 2026
Effective date
Sep 10, 2026
Identified
Sep 11, 2026
Summary
This revised Medicare Advantage policy (effective 09/10/2026) establishes coverage criteria for molecular marker testing in fine needle aspirates of thyroid nodules, including Afirma GSC, ThyGeNext/ThyraMIRv2, and ThyroSeq v3 GC tests. Coverage is determined by applicable MAC Local Coverage Determinations (LCDs) in each jurisdiction, with specific criteria varying by geographic region and test type.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
by Sep 10, 2026 · 6 steps
01Billing team must update authorization protocols and billing system rules to implement jurisdiction-specific LCD requirements for thyroid nodule molecular testing.
02Map each practice location to its applicable MAC jurisdiction (J5/J8, J6/JK, J15, JE/JF, JH/JL, JJ/JM, or JN) using the CMS jurisdiction table provided in the policy.
03For each jurisdiction, retrieve and integrate the applicable LCD(s) from the Related CMS Documents section—particularly L39682 (MolDX thyroid testing), L35396 (Biomarkers for Oncology), or L38968 (Thyroid Nodule Molecular Testing).
04Update prior authorization requirements in billing software to reflect jurisdiction-specific medical necessity criteria for CPT 81546 (Afirma GSC), CPT 0245U (ThyGeNext), CPT 0018U/81599 (ThyraMIRv2), and CPT 0026U (ThyroSeq v3 GC).
05Ensure providers document that tests are ordered by treating physicians for beneficiary management of specific thyroid nodule cases and that specimens are from fine needle aspirates.
06Train billing and prior authorization staff on jurisdiction-specific rules, particularly for multiple thyroid nodule testing variations noted in the policy.
If missed: Failure to apply correct jurisdiction-specific LCDs will result in claim denials for non-compliant requests.
Codes mentioned
8154681599
Original notice
Molecular Markers in Fine Needle Aspirates of Thyroid Nodules - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Gene Expression Profiling for Cancer Indications - MEDICAID - FLORIDA (Revised)MediumEffective Oct 21, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - VIRGINIA (Revised)HighEffective Oct 14, 2026 · MedicaidGenomic and Molecular Biomarker Testing for Cancer - MEDICAID - MICHIGAN (New)HighEffective Sep 23, 2026 · MedicaidGene Expression Profiling for Cancer Indications - MEDICAID - SOUTH CAROLINA (Revised)MediumEffective Sep 23, 2026 · MedicaidBrowse every Humana change in the policy list