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Headache and Occipital Neuralgia Treatments - Medicare Advantage (Revised)
Effective date
Nov 2, 2026
Identified
Oct 29, 2026
Summary
Humana revised its Medicare Advantage policy on headache and occipital neuralgia treatments effective 11/02/2026, expanding coverage criteria for occipital nerve stimulation and trigger point injections while maintaining exclusions for certain surgical interventions and specific conditions (neck pain, tension headache, cluster headache). Billing teams must verify applicability of jurisdiction-specific LCDs and update medical necessity criteria in their review processes for affected procedure codes.
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What to do
Action · 5 steps
01Utilization Management and Prior Authorization teams must update medical necessity criteria to align with LCDs L33933 (Peripheral Nerve Blocks for occipital nerve denervation - CPT 64640) and L34328 (Peripheral Nerve Stimulation - CPT 64553, 64555, 64575 and HCPCS C1767, C1820, C1822, C1827, L8682-L8688) for jurisdictions without local guidance (J5/J8, J6/JK, J15, JH/JL, JJ/JM, JN).
02Billing team must implement hard denials in the claims system for non-covered procedures: occipital nerve stimulation for neck pain or tension headache; vagal/trigeminal nerve stimulation via pressure-activated external/middle ear sensors; and surgical interventions including supraorbital/supratrochlear decompression (64708), occipital microdecompression, neuroplasty (64716), occipital nerve transection/avulsion (64744), and cranial sensory nerve transposition.
03Trigger point injection (CPT 20552, 20553) requests for headache in jurisdictions JH/JL and JN must be evaluated against LCD L39713 criteria.
04Prior authorization workflows must exclude coverage for occipital nerve stimulation in cluster headache across all jurisdictions.
05Billing team and providers must confirm member's specific Medicare Advantage plan and geographic MAC jurisdiction to determine which LCD applies, as policy contains jurisdiction-specific exceptions.
If missed: Failure to apply correct medical necessity criteria or implement exclusions will result in claim denials and potential recoupment.
Codes mentioned
646406455364555645752055220553647166470864744C1767C1820C1822C1827L8682L8683L8685L8686L8687L8688
Original notice
Headache and Occipital Neuralgia Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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