Medicare AdvantagePrior AuthMedium impact
Amtagvi (lifileucel) - Medicare Advantage (Revised)
Humana·Oncology, Dermatology, Internal Medicine·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Jul 30, 2026
Summary
Humana Medicare Advantage has established a new coverage policy for Amtagvi (lifileucel), a tumor-infiltrating lymphocyte (TIL) immunotherapy for adults 18+ with unresectable or metastatic melanoma who have failed PD-1 inhibitors and applicable BRAF inhibitors. Coverage requires medical director review and ALL specified clinical criteria to be met. All requests must be referred to the Corporate Transplant Department. This policy is effective immediately for billing and authorization purposes.
Action Required
By August 3, 2026: Billing team must implement the following: (1) Set up prior authorization routing in billing system to automatically flag all Amtagvi (lifileucel) claims (codes C9399, J3490, J3590, XW033L7, XW043L7) for mandatory medical director review before processing; (2) Create authorization checklist requiring documentation of: patient age ≥18, unresectable/metastatic melanoma diagnosis, prior PD-1 inhibitor treatment with documented progression, and prior BRAF/MEK inhibitor treatment (if BRAF V600 mutation positive) with documented progression; (3) Establish that ALL claims must include one of the two ICD-10-PCS codes (XW033L7 for peripheral vein or XW043L7 for central vein administration); (4) Direct all authorization requests to Corporate Transplant Department (1-866-421-5663, fax 502-508-9300, transplant@humana.com); (5) Deny coverage and communicate to providers if patient meets any exclusion criteria: desire/planning for pregnancy, unwilling to use contraception, currently pregnant, or breastfeeding. Claims submitted without meeting ALL coverage criteria will be denied as not medically necessary. Providers should be notified of these requirements immediately to allow lead time for prior authorization submissions.