Medicare AdvantageCoverageMedium impact
Facility Based Sleep Studies - Medicare Advantage (Revised)
Humana·Sleep Medicine, Pulmonology, Neurology +1 more·Medicare Advantage
Effective date
Nov 2, 2026
We identified it
Oct 28, 2026
Summary
Humana Medicare Advantage revised its Facility Based Sleep Studies policy (HUM-1255-009), effective 11/02/2026. The policy clarifies coverage criteria for facility-based sleep studies (CPT 95807, 95808, 95810, 95811) across multiple jurisdictions, referencing applicable CMS LCDs and requiring compliance with MAC-specific local coverage determinations based on geographic jurisdiction. This is a revision of the original policy effective 01/01/2024.
Action Required
By 2026-11-02: Billing team must verify and update documentation, prior authorization, and claims processing workflows for facility-based sleep study codes (95807, 95808, 95810, 95811) to align with the revised Humana Medicare Advantage policy. Confirm the applicable MAC jurisdiction for your state and ensure compliance with the corresponding CMS LCD (e.g., L36902 for jurisdictions J6/JK, L36839 or L36902 or L36861 or L35050 or L36593 or L33405 depending on geographic location). Update any internal guidelines or fee schedules that reference the previous 01/01/2024 version. Verify that prior authorization processes incorporate the revised medical necessity criteria for narcolepsy, parasomnias, split-night studies, repeat studies, and PAP device replacement as outlined. For repeat studies and PAP device guidance, reference CMS LCD L33718. For hypoglossal nerve stimulation-related PSG requirements, reference the applicable CMS LCD. Claims submitted after the effective date that do not meet the revised criteria may be denied as medically unnecessary.