Medicare AdvantageCoverageHigh impact
Carpal Tunnel Syndrome Surgical Treatments - Medicare Advantage (Revised)
Humana·Orthopedics, Neurosurgery, General Surgery +1 more·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Jul 30, 2026
Summary
Humana Medicare Advantage has updated its carpal tunnel syndrome surgical treatment coverage policy (effective 08/03/2026). The policy now specifies that only endoscopic or open carpal tunnel release surgery (CPT 29848, 64721) is covered when strict medical necessity criteria are met. Alternative surgical techniques (TCTR, PCTR, balloon carpal tunnelplasty) and adjunctive procedures (epineurotomy, flexor tenosynovectomy, neurolysis, flexor retinaculum reconstruction) are explicitly NOT covered due to insufficient evidence.
Action Required
By August 3, 2026: Billing team must update billing software and denial rules to reflect coverage restrictions. (1) ALLOW reimbursement for CPT 29848 and 64721 ONLY when documented evidence includes: electrodiagnostic testing showing moderate-severe median nerve injury, OR thenar atrophy, OR clinical signs (sensory loss, paresthesia, sleep-disrupting pain, hand dysfunction) WITH positive provocative maneuver AND failed conservative treatment (4-week splint trial OR temporary relief from corticosteroid injection). (2) DENY all claims for CPT 64728 (balloon carpal tunnelplasty), CPT 64999 (if balloon procedure), thread carpal tunnel release, ultrasound-guided percutaneous carpal tunnel release, and adjunctive procedures (epineurotomy, flexor tenosynovectomy, neurolysis, flexor retinaculum reconstruction) with reason: "Not medically reasonable and necessary per Humana policy HUM-1041-005." (3) Update prior authorization templates to require documentation of EMG/NCS results, provocative test findings, and conservative treatment failure. (4) Communicate to providers and coding staff that only standard endoscopic or open approaches are reimbursable; alternative techniques will be denied. Claims submitted for non-covered procedures will be denied without exception.