Medicare AdvantageCoverageHigh impact
Brachytherapy - Medicare Advantage (Revised)
Humana·Oncology, Neurosurgery, Radiation Oncology +1 more·Medicare Advantage
Effective date
Oct 1, 2026
We identified it
Sep 29, 2026
Summary
Humana Medicare Advantage has issued a revised Brachytherapy coverage policy (HUM-1028-009, effective 10/01/2026) that consolidates coverage criteria for multiple brachytherapy techniques across oncologic indications including brain cancer, breast cancer, cholangiocarcinoma, and esophageal cancer. The policy establishes specific medical necessity requirements for each indication and references applicable Local Coverage Determinations for intraoperative brachytherapy.
Action Required
By September 30, 2026: Billing and clinical teams must review and implement the revised Brachytherapy coverage policy in all systems and workflows. Specific actions required: (1) Update billing software to enforce medical necessity criteria for brachytherapy claims across all covered indications (brain cancer, breast cancer, cholangiocarcinoma, esophageal cancer); (2) Configure prior authorization requirements for CPT codes 77424, 77425, and C9726 based on applicable MAC jurisdiction and LCD requirements; (3) For breast cancer APBI claims, implement automated edits requiring documentation of patient age (≥40), BRCA status (negative), node-negative status, tumor size (≤2cm), negative margins, and histology confirmation; (4) Update encounter templates and clinical documentation requirements to capture all mandated criteria; (5) Train providers and billing staff on new coverage requirements to ensure accurate claim submission. Failure to implement these requirements will result in claim denials for non-compliant submissions.