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Gene Expression Profiling for Cancer Indications - Medicare Advantage (Revised)
Effective date
Oct 12, 2026
Identified
Oct 10, 2026
Summary
Humana Medicare Advantage revised its Gene Expression Profiling for Cancer Indications policy (HUM-1092-017), effective 2026-10-12. This is a policy update/reissuance that consolidates coverage guidance for molecular biomarker and gene expression tests across multiple cancer types (breast, prostate, lung, melanoma, colon, and cutaneous squamous cell carcinoma). The policy references MAC-specific Local Coverage Determinations (LCDs) and billing codes that apply by geographic jurisdiction; billing teams must verify applicable LCD requirements for their service area.
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What to do
Action · 7 steps
01Effective 2026-10-12: Billing team must review and implement the revised Gene Expression Profiling policy (HUM-1092-017) for all Medicare Advantage claims.
02Identify your practice's Medicare Administrative Contractor (MAC) jurisdiction from the policy's geographic table (J5, J6, J8, JE, JF, JH, JL, JJ, or JM).
03Locate and review the corresponding MAC-specific LCDs and Local Coverage Articles (LCAs) listed in the policy document for your jurisdiction—these establish specific coverage criteria, billing codes, and prior authorization requirements for individual gene expression tests (e.g., Oncotype DX, Prosigna, EndoPredict, MammaPrint, BluePrint).
04Update billing workflows, templates, and prior authorization procedures to align with the applicable MAC LCD requirements for your geographic area.
05Train billing and clinical staff on the coverage determination process for each test type within your jurisdiction.
06Failure to comply with MAC-specific LCDs may result in claim denials.
07Refer to the CMS Medicare Coverage Database and your MAC's website for the most current LCD details, as this policy references but does not reproduce the full LCD text.
Original notice
Gene Expression Profiling for Cancer Indications - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
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