Medicare AdvantageCoverageHigh impact
Cardiac Catheterization and Coronary Angiography - Medicare Advantage (Revised)
Humana·IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH · Cardiology, Internal Medicine, Critical Care·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Jul 30, 2026
Summary
Humana Medicare Advantage has updated its cardiac catheterization and coronary angiography coverage policy (Policy HUM-1034-008), effective 08/03/2026. The policy establishes specific medical necessity criteria for coronary/bypass angiography procedures, requiring documented moderate to severe ischemia confirmed by nuclear imaging, echocardiography, cardiac MRI, or exercise testing. Billing teams must verify these criteria are met and documented before submitting claims to avoid denials.
Action Required
By July 15, 2026: Billing team must implement claims edits to require documentation of ischemia confirmation for CPT codes 93454-93461 submitted under Medicare Advantage plans. Update billing system to flag claims lacking one of the following: (1) Nuclear perfusion SPECT/PET with ≥10% ischemic myocardium, (2) Echocardiogram with ≥3/16 segments with stress-induced severe hypokinesis/akinesis or wall motion index >1.1, (3) Cardiac MRI perfusion with ≥12% ischemia and/or ≥3/16 wall motion segments, or (4) Exercise ECG test meeting specific ST-segment criteria. Educate providers and documentation staff that all cardiac catheterization/angiography requests must include supporting diagnostic test results. Claims without proper documentation will be denied as not medically necessary. Update pre-authorization templates to require ischemia confirmation documentation.