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Low Frequency, Noncontact, Nonthermal Ultrasound for Wound Care - Medicare Advantage (Revised)
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
This is a revised Medicare Advantage policy for low frequency, noncontact, nonthermal ultrasound (MIST Therapy) for wound care, effective October 1, 2026. The policy clarifies medical necessity criteria across multiple MAC jurisdictions, requiring that standard wound care demonstrate no improvement or be contraindicated before this therapy is covered. Billing teams must ensure claims include proper documentation of failed standard care and route requests through applicable regional MACs.
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What to do
by Sep 30, 2026 · 6 steps
01Billing team must update systems to align with revised medical necessity criteria for CPT 97610 across all applicable MAC jurisdictions (J5/J8, J15, JJ/JM, JN, and others listed in the policy).
02Ensure claims documentation includes: (1) evidence that standard wound care (debridement, etc.) showed no improvement or is contraindicated, and (2) appropriate MAC routing based on patient geography.
03Providers must document this justification in patient records before submitting claims.
04Update encounter templates and prior authorization forms to require this documentation.
05Route claims to the appropriate regional MAC per the jurisdiction table in the policy.
06Claims submitted without evidence of failed standard care may be denied as not medically necessary.
Codes mentioned
97610
Original notice
Low Frequency, Noncontact, Nonthermal Ultrasound for Wound Care - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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