Medicare AdvantageCoverageMedium impact
MA11.068g, Sentinel Lymph Node Biopsy and Mapping
Independence Blue Cross·General Surgery, Oncology, Plastic Surgery +1 more·Medical Policy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria for sentinel lymph node biopsy and mapping procedures. The billing team needs to review updated coverage requirements that will take effect April 20, 2026.
Action Required
Before April 20, 2026: Billing team must review updated medical necessity criteria for sentinel lymph node biopsy and mapping procedures for Medicare Advantage plans. Access the full policy at the provided URL to understand new documentation requirements. Update prior authorization protocols and ensure providers are aware of revised criteria to prevent claim denials.