Coronary CT Angiography, Fractional Flow Reserve with CT and Adjunctive Testing - Medicare Advantage (Revised)
Humana·IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH, CA, HI, NV, AS, GU, MP, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AL, GA, TN, NC, SC, VA, WV · Cardiology, Radiology, Internal Medicine·Medicare Advantage
Effective date
Jul 1, 2026
We identified it
Jun 30, 2026
Days to comply
—
Summary
This is a Medicare Advantage policy revision (effective 07/01/2026) for Coronary CT Angiography, Fractional Flow Reserve with CT, and adjunctive cardiac testing. The policy establishes that Humana follows applicable Local Coverage Determinations (LCDs) by MAC jurisdiction for CCTA (CPT 75574) and FFRCT (CPT 75580), with specific LCD guidance for each geographic region. Billing teams must ensure prior authorization and medical necessity documentation align with the applicable LCD in the patient's service area.
Action Required
Action needed
By June 30, 2026: Billing team must update system rules to map patient service areas to the correct MAC jurisdiction and associated LCD (L33423, L33947, L35121, L33559 for CCTA; L38278, L38613, L38771, L38839, L39075 for FFRCT). For jurisdictions without a specific LCD (JE/JF, JH/JL, JN), apply LCD L33559 for CCTA and LCD L38771 for FFRCT. Prior to submitting CPT 75574 or CPT 75580 claims, providers must document that cases meet the medical necessity criteria in the applicable LCD. Update prior authorization workflows to reference the correct LCD by MAC region. Failure to follow the appropriate LCD will result in claim denials. Training required for billing staff to identify MAC jurisdiction by state/territory at point of service.