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Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)
Effective date
Oct 12, 2026
Identified
Oct 10, 2026
Summary
Humana Medicare Advantage updated its genetic testing policy for hereditary breast, ovarian, pancreatic, and prostate cancer, effective 10/12/2026. The policy clarifies coverage determination criteria, referencing CMS National Coverage Determinations, Local Coverage Determinations, and the MolDX registry. Billing teams must verify their jurisdiction's applicable MAC guidance and ensure genetic testing orders meet medical necessity criteria before processing claims.
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What to do
Action · 4 steps
01Effective 10/12/2026: Billing team should verify the applicable Medicare Administrative Contractor (MAC) jurisdiction for each claim location using the provided MAC-to-state mapping table.
02For claims in jurisdictions J6/JK, JH/JL, or JN without complete CMS guidance, reference LCD L38972 – MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer to determine medical necessity before processing genetic testing claims.
03Update internal documentation and billing software to reflect the new effective date and ensure all genetic testing orders include physician medical justification tied to the patient's personal or family history of hereditary cancer.
04Confirm current applicability of prior billing practices under the original 01/01/2024 policy and transition to the revised 10/12/2026 criteria to avoid claim denials.
Original notice
Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageGenetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)MediumEffective Oct 1, 2026 · Medicare AdvantageGenetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)HighEffective Aug 3, 2026 · Medicare AdvantageGenetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer - Medicare Advantage (Revised)MediumEffective Sep 2, 2025 · Medicare AdvantageBrowse every Humana change in the policy list