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HumanaMedicare Advantage · Coverage · Medicare Advantage · IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, CA, HI, NV, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR · Bariatric Surgery, General SurgeryHigh impact

Bariatric Surgery - Medicare Advantage (Revised)

Act
by Sep 1, 2026
Effective date
Oct 1, 2026
Identified
Sep 29, 2026

Summary

This is a comprehensive Medicare Advantage bariatric surgery coverage policy (HUM-1020-005) effective October 1, 2026, that outlines coverage determinations, limitations, and coding requirements for various bariatric procedures. The policy applies Humana's Medicare Advantage coverage standards and references applicable MAC Local Coverage Determinations by geographic jurisdiction, with specific rules varying by state and MAC region.

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What to do

by Sep 1, 2026 · 7 steps
01Billing team must review and implement the complete Bariatric Surgery policy (HUM-1020-005) for all Medicare Advantage bariatric surgery claims.
02Identify which MAC jurisdiction applies to each state your practice serves using the MAC reference table (J5/J8 for IA/KS/MO/NE/IN/MI; J6/JK for IL/MN/WI/CT/MA/ME/NH/NY/RI/VT; JE/JF for CA/HI/NV/AK/AZ/ID/MT/ND/OR/SD/UT/WA/WY; JH/JL for AR/CO/LA/MS/NM/OK/TX/DE/DC/MD/NJ/PA; JJ/JM for AL/GA/TN/NC/SC/VA/WV; JN for FL/PR/US VI).
03Update billing software to apply the correct LCD requirements for each geographic region.
04Obtain and integrate the specific LCAs and LCDs referenced in the policy table (e.g., A54923, A52447, L35022, L34576, L33411) into your prior authorization and coding workflows.
05Ensure providers understand coverage limitations for each procedure type (restrictive, malabsorptive, combination, and endoscopic approaches).
06Update prior authorization templates to align with the policy's coverage determinations and medical necessity requirements.
07Train billing and clinical staff on the differences between covered procedures (LSG, RYGB, BPD/DS, LAGB, etc.) and investigational procedures (NOTES techniques, endoscopic approaches).
If missed: Failure to apply the correct MAC LCD will result in claim denials and improper reimbursement.

Original notice

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

See all Humana changes →
Bariatric Surgery - Medicare Advantage (Revised)MediumEffective Feb 2, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

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