Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
HumanaMedicare Advantage · Coverage · Medicare Advantage · Oncology, Radiation Oncology, General Surgery +1 moreMedium impact

Hyperthermia and Ultrasound Based Ablative Cancer Treatments - Medicare Advantage (Revised)

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Oct 2, 2026

Summary

This is a comprehensive Medicare Advantage policy update (effective 10/01/2026) establishing coverage criteria for hyperthermia and ultrasound-based ablative cancer treatments. The policy provides specific medical necessity requirements for HIPEC, ILI/ILP, and laser therapy procedures, with defined billing codes and clinical indications that billing teams must verify before claim submission.

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 30, 2026 · 6 steps
01Billing team must implement the following changes in billing software and prior authorization workflows.
02For CPT 96547 and 96548 (HIPEC), require documentation confirming use with cytoreductive surgery AND one of three qualifying diagnoses: gastric cancer without peritoneal/distant metastases, peritoneal carcinomatosis without extraperitoneal metastases, or pseudomyxoma peritonei.
03For CPT 36823 (ILI/ILP), verify treatment is for stage III in-transit melanoma only.
04Update encounter templates and prior auth request forms to capture required clinical indicators.
05Providers must document medical necessity according to these criteria or claims will be denied as not medically necessary.
06Clinical staff should be trained on the specific coverage requirements for each procedure code.

Codes mentioned

965479654836823

Original notice

Hyperthermia and Ultrasound Based Ablative Cancer Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
View original ↗

Related changes

See all Humana changes →
Hyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)MediumEffective Apr 1, 2026 · Medicare AdvantageHyperthermia and Ultrasound-Based Ablative Cancer Treatments - Medicare Advantage (Revised)MediumEffective Apr 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

Related policy hubs

Humana policiesOncologyRadiation OncologyGeneral SurgeryUrologyCode 96547Code 96548Code 36823

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account