Medicare AdvantageCoverageHigh impact
Computed Tomography Angiography (CTA) of the Chest, Abdomen and Pelvis - Medicare Advantage (Revised)
Humana·Radiology, Cardiology, Cardiothoracic Surgery +6 more·Medicare Advantage
Effective date
Jul 1, 2026
We identified it
Jun 30, 2026
Summary
Humana Medicare Advantage has issued a revised CTA (Computed Tomography Angiography) policy effective July 1, 2026, establishing specific medical necessity criteria for CTA chest (noncoronary), abdomen, and pelvis imaging. The policy provides detailed coverage guidelines supplementing CMS NCD 220.1, replacing any prior guidance with explicit indications across chest, abdominal, and pelvic imaging scenarios. Billing teams must align authorizations and claim submissions to these new criteria to ensure coverage and payment.
Action Required
By June 15, 2026: Billing team and prior authorization staff must review and implement the revised CTA medical necessity criteria into the authorization system. (1) Update authorization protocols in billing software to require documentation of at least one covered indication from the policy for CPT 71275 (chest CTA), 72191 (abdomen/pelvis CTA), 74174 (abdomen/pelvis CTA), and 74175 (abdomen/pelvis CTA). (2) Create or update authorization request templates to include the 40+ specific indications listed in the policy (e.g., blunt chest trauma, hemoptysis, pulmonary embolism evaluation, aortic aneurysm surveillance, GI bleeding, AAA repair follow-up). (3) Train all staff responsible for prior authorization on the new indications—requests lacking documented medical necessity from these criteria will be denied effective July 1, 2026. (4) Notify providers and clinical documentation teams of the effective date and required documentation elements. (5) Review pending authorizations under old policy guidance and re-evaluate against new criteria before effective date. Failure to align with these criteria will result in claim denials and coverage disputes.