← Back to list
Single Gene and Molecular Biomarker Testing for Solid Tumors - Medicare Advantage (Revised)
Effective date
Oct 12, 2026
Identified
Oct 15, 2026
Summary
Humana Medicare Advantage revised its policy on Single Gene and Molecular Biomarker Testing for Solid Tumors, effective 10/12/2026. The policy now applies to testing such as FGFR, KIT, KRAS, MET, NRAS, NTRK, PDGFRA, PIK3CA, RET, ROS1, TERT, TP53, PD-L1, FOLR1, and related molecular biomarker tests (including IHC, MGMT promoter methylation, MSI/MMR). Billing teams must verify current coverage determinations and coding requirements under the revised policy and associated MAC LCDs/LCAs referenced for their geographic jurisdiction.
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
Action · 4 steps
01Already effective 10/12/2026: Billing team should verify that the practice's current billing workflows, prior authorization processes, and coding submissions for single gene and molecular biomarker testing align with Humana's revised HUM-1236-004 policy.
02Review the specific MAC LCD/LCA documents applicable to your geographic jurisdiction (listed in the Related CMS Documents section by state and contractor) to confirm which tests require prior authorization, which CPT/HCPCS codes are covered, and any documentation requirements.
03Update internal billing guidelines and prior authorization submission templates as needed to reflect coverage determinations in the revised policy.
04Recommend confirming current applicability with Humana directly, as the source document does not specify what substantive coverage changes were made in the revision from the original 05/01/2025 effective date.
Original notice
Single Gene and Molecular Biomarker Testing for Solid Tumors - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Gene Expression Profiling - Medicare Advantage (Revised)MediumEffective Nov 2, 2026 · Medicare AdvantageGenetic Testing for Hematologic Malignancies and Suspected Myeloid Disorders - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageGene Expression Profiling for Cancer Indications - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageComprehensive Genomic Profiling and Multigene Panel Testing for Solid Tumors - Medicare Advantage (Revised)MediumEffective Oct 12, 2026 · Medicare AdvantageBrowse every Humana change in the policy list