Medicare AdvantageCoverageMedium impact
Irreversible Electroporation - Medicare Advantage (Revised)
Humana·AL, GA, TN, NC, SC, VA, WV · Oncology, Urology, General Surgery·Medicare Advantage
Effective date
Jul 5, 2026
We identified it
Jun 30, 2026
Summary
Humana Medicare Advantage is revising coverage for Irreversible Electroporation (IRE) ablation procedures, effective July 5, 2026. Coverage applies only to jurisdictions JJ/JM (Palmetto GBA MAC: AL, GA, TN, NC, SC, VA, WV) and requires adherence to LCD L40205 criteria. In all other jurisdictions (J5/J8, J6/JK, J15, JE/JF, JH/JL, JN), IRE is NOT covered as medically reasonable and necessary. Two new CPT codes (47384, 55877) effective January 1, 2026 define liver and prostate ablation procedures.
Action Required
By June 30, 2026: Billing team must implement jurisdiction-specific coverage rules in billing system. For Palmetto GBA jurisdictions (JJ/JM: AL, GA, TN, NC, SC, VA, WV), configure system to require prior authorization based on LCD L40205 criteria for CPT 47384 and 55877. For all other jurisdictions, configure system to automatically deny CPT 47384, 55877, 0600T, and 0601T as non-covered services with denial reason: 'Evidence insufficient; not standard medical treatment.' Before January 1, 2026: Update billing software to recognize new CPT codes 47384 and 55877. Effective immediately: Stop billing IRE procedures in non-LCD jurisdictions and educate providers that these procedures are not covered. Update encounter forms and provider bulletins with jurisdiction-specific guidance. Flag all pending IRE claims for review and potential rework based on member's geographic location.