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HumanaMedicare Advantage · Coverage · Medicare Advantage · Pain Management, Orthopedics, Neurosurgery +2 moreMedium impact

Injections for Pain Conditions - Medicare Advantage (Revised)

Effective date
Oct 25, 2026
Identified
Oct 24, 2026

Summary

Humana Medicare Advantage revised its Medical Coverage Policy for Injections for Pain Conditions (Policy HUM-1137-011) effective 10/25/2026. This update consolidates coverage guidance for epidural steroid injections, facet joint injections, sacroiliac joint injections, trigger point injections, nerve blocks, and dry needling across multiple Medicare Administrative Contractor (MAC) jurisdictions. Billing teams must verify current MAC-specific Local Coverage Determinations (LCDs) applicable to their geographic region, as coverage rules and documentation requirements vary by MAC jurisdiction.

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What to do

Action · 6 steps
01By 2026-10-25 (now effective): Billing and clinical teams should verify that the practice's current pain injection billing procedures align with the revised Humana Medicare Advantage policy HUM-1137-011.
02Identify the applicable Medicare Administrative Contractor (MAC) jurisdiction for your practice location using the policy's MAC table (J5, J6, J8, J15, JE, JF, JH, JL, JJ, JM, or JN).
03Cross-reference the policy's related CMS documents to obtain the specific Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) for your MAC, including guidelines for epidural steroid injections, facet joint interventions, sacroiliac joint injections, trigger point injections, and peripheral nerve blocks.
04Update your billing system and prior authorization workflows to reflect any changes in MAC-specific coverage criteria, documentation requirements, or approved procedure codes.
05Confirm applicability of this policy to your current patient population and ensure providers understand any modified diagnostic vs. therapeutic injection protocols outlined in the policy.
06Flag any claims currently in process for pain injections and validate against the new effective date to prevent claim denials.

Original notice

Injections for Pain Conditions - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

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Humana policiesPain ManagementOrthopedicsNeurosurgeryAnesthesiologyPhysical Therapy

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