Medicare AdvantageCoverageMedium impact
Lymphedema - Diagnosis and Treatment - Medicare Advantage (Revised)
Humana·Oncology, Physical Therapy, Occupational Therapy +3 more·Medicare Advantage
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
This is a Medicare Advantage policy revision (effective 07/01/2026) that establishes coverage criteria for lymphedema diagnosis and treatment services, including bioimpedance spectroscopy (BIS), compression garments, manual lymph drainage, and pneumatic compression devices. The policy specifies medical necessity requirements, frequency limits, and eligible patient populations for Humana Medicare Advantage plans.
Action Required
By June 1, 2026: Billing team must review and update prior authorization protocols for lymphedema services to align with Humana's updated coverage criteria. Specifically: (1) Update billing system to enforce BIS (CPT 93702) frequency limit of 4 times per year for first year post-lymph node removal/damage/irradiation; (2) Require documentation in claims that patients meet one of the specified criteria (developed lymphedema, at-risk status with BMI ≥30 or postoperative infection, or undergoing breast cancer treatment); (3) Add internal checklist for providers documenting whether baseline BIS is preoperative for cancer treatment patients; (4) Update encounter forms and clinical templates to capture required documentation elements; (5) Train coding and authorization staff on the distinction between covered compression devices (unicompartmental, multicompartmental, advanced programmable, CircuFlow 5200, nonpneumatic, VenoWave); (6) Verify MAC jurisdiction coverage rules from Noridian (JE/JF) for applicable geographic areas. Claims submitted without proper documentation of medical necessity will be denied.