← Back to list
Interspinous Process Decompression Spacers - Medicare Advantage (Revised)
Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
Humana Medicare Advantage has issued a revised policy (effective 10/01/2026) that declares interspinous process decompression spacers (including Superion/Vertiflex devices) as NOT medically reasonable and necessary. This is a non-coverage determination, meaning claims for CPT 22869, 22870, and HCPCS C1821 will be denied for all Medicare Advantage members. Billing teams must update denial protocols and inform providers immediately.
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 15, 2026 · 3 steps
01Billing team must update billing software and claim scrubbing rules to automatically deny and route claims containing CPT 22869, 22870, and HCPCS C1821 for all Humana Medicare Advantage members, with denial reason 'Not medically necessary per policy HUM-1139-006.' Before September 30, 2026: Notify all spine surgeons, orthopedic surgeons, and neurosurgeons in network that interspinous spacer procedures are no longer covered; update provider bulletins and EMR templates to alert providers during order entry.
02Before October 1, 2026: Update patient authorization and financial counseling scripts to inform members that this procedure is not a covered benefit.
03Monitor first 30 days post-effective date for any claims submitted in error and ensure prompt denial with clear explanation of non-coverage determination.
If missed: Failure to implement will result in improper claims payments and potential recovery audits.
Codes mentioned
2286922870C1821
Original notice
Interspinous Process Decompression Spacers - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage (Revised)HighEffective Sep 1, 2026 · Medicare AdvantageInterspinous Process Decompression Spacers - Medicare Advantage (Revised)MediumEffective Nov 3, 2025 · Medicare AdvantageBrowse every Humana change in the policy list