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Gene Expression Profiling - Medicare Advantage (Revised)
Effective date
Nov 2, 2026
Identified
Oct 29, 2026
Summary
Humana Medicare Advantage updated its Gene Expression Profiling policy (HUM-1092-018) effective 11/02/2026. The policy provides coverage guidelines for molecular biomarker and gene expression tests across multiple cancer types (breast, prostate, lung, melanoma, cutaneous squamous cell carcinoma) and pulmonary conditions, referencing MAC-specific LCDs and billing/coding articles. Billing teams should verify applicability of this revised policy to their patient population and confirm alignment with the applicable Medicare Administrative Contractor's local coverage determinations.
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What to do
Action · 5 steps
01Effective 11/02/2026: Billing team should review Humana Medicare Advantage policy HUM-1092-018 (Gene Expression Profiling) and confirm current applicability to the practice.
02Cross-reference the applicable Medicare Administrative Contractor (MAC) jurisdiction-specific Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) listed in the policy for the geographic regions served.
03Verify that current billing workflows and documentation requirements align with the revised policy, particularly for gene expression tests referenced (Prosigna, Oncotype DX, EndoPredict, MammaPrint, Envisia, and molecular biomarker panels for cancer risk stratification).
04Ensure prior authorization processes, if required by the applicable MAC LCD, are properly configured in billing software before submitting claims.
05Do not assume prior versions remain in effect; confirm the 11/02/2026 version supersedes the original 01/01/2024 policy.
Original notice
Gene Expression Profiling - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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