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Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
This is a Medicare Advantage policy update (effective 10/01/2026) covering noninvasive tests for hepatic fibrosis, including imaging-based tests (MRE, qMRA) and blood-based biomarker panels (ELF, FIB-4, FibroSure, LiverFASt, NIS4, OWLiver, TruD, HepQuantDuO). The policy establishes coverage determination criteria for these tests across multiple MAC jurisdictions. The document provided is incomplete and does not contain the full coverage determination criteria, medical necessity requirements, or specific billing code guidance needed for implementation.
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What to do
Action · 5 steps
01REQUIREMENTS:
- By September 8, 2026 (policy review date): Billing and clinical teams must obtain the complete policy document (document appears truncated) to identify all coverage criteria, medical necessity requirements, prior authorization rules, and applicable billing codes for hepatic fibrosis noninvasive tests.
02- Before October 1, 2026 (effective date): Update billing system rules and prior authorization workflows to reflect coverage requirements for noninvasive hepatic fibrosis tests across applicable MAC jurisdictions (J5, J8, J15, JE, JF, JJ, JM).
03- Gastroenterology and hepatology providers must update encounter forms and documentation templates to capture required clinical criteria for medical necessity determinations.
04- Verify which MAC jurisdiction applies to your practice location and implement jurisdiction-specific coverage rules.
05- Contact Humana directly to obtain the complete policy text beyond page 5, as the provided document ends mid-sentence in the Coverage Determination section.
Original notice
Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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