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HumanaMedicare Advantage · Coverage · Medicare Advantage · IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH, CA, HI, NV, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR · Pain Management, Neurosurgery, Anesthesiology +1 moreMedium impact

Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)

Effective date
Nov 1, 2026
Identified
Nov 3, 2026

Previous versions

Summary

Humana Medicare Advantage revised its neuroablative techniques for chronic pain policy effective 11/01/2026. The policy update describes coverage criteria, limitations, and coding guidance for multiple denervation procedures (radiofrequency ablation, cryotherapy, facet denervation, basivertebral nerve ablation, and other neuroablative techniques). The practice must verify applicable MAC LCDs by geographic jurisdiction, obtain prior authorization as required, and ensure claims are submitted with correct coding and documentation.

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What to do

Action · 8 steps
01Effective 11/01/2026, the billing team must.
02Identify which MAC jurisdiction(s) serve the practice's patient population using the policy's MAC/state table (J5, J6, J8, J15, JE, JF, JH, JL, JJ, JM, JN).
03Obtain and review the specific LCD and LCA documents for each applicable MAC (e.g., Facet Joint Interventions, Peripheral Nerve Injections and Procedures, Sacroiliac Joint Injections and Procedures, Basivertebral Nerve Ablation) listed in the policy.
04For Humana Medicare Advantage members, get prior authorization before scheduling any neuroablative procedure (facet denervation, RFA, cryoablation, basivertebral nerve ablation, iovera system, laser ablation, pulsed RF, cooled RF, chemical neurolysis, or cryotherapy) because claims without prior auth will be denied.
05Update charge entry and claim templates to include the correct CPT/HCPCS codes, modifiers, and diagnosis codes specified in the applicable MAC LCDs.
06Attach or improve documentation to show the procedure meets medical necessity criteria in the applicable LCD (e.g., evidence of failed conservative treatment, imaging confirmation of target anatomy, appropriate patient selection).
07Tell providers and front desk staff which neuroablative procedures require prior authorization before scheduling, noting that coverage rules vary by MAC jurisdiction.
08Monitor for any future LCD updates from the applicable MACs, as this Humana policy requires compliance with current MAC LCDs for all geographic areas.

Original notice

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

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Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)MediumEffective Oct 25, 2026 · Medicare AdvantageNeuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)HighEffective Aug 6, 2026 · Medicare AdvantageNeuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)HighEffective Aug 6, 2026 · Medicare AdvantageNeuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)HighNo effective date · Medicare AdvantageBrowse every Humana change in the policy list

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