Medicare AdvantageCoverageMedium impact
Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Jul 30, 2026
Summary
Humana Medicare Advantage has updated its CAR T-cell Therapy medical coverage policy (effective 08/03/2026), providing standardized coverage determination criteria across all approved CAR-T therapies. The policy establishes specific billing codes (CPT 38225-38228, HCPCS Q2041-Q2058, ICD-10-PCS XW033/XW043 codes) and references individual pharmacy policies for each CAR-T product. Billing teams must ensure claims align with the referenced drug-specific pharmacy policies to avoid denials.
Action Required
Before 08/03/2026: Billing team must cross-reference CAR-T therapy claims against the seven referenced Humana pharmacy coverage policies (Abecma, Aucatzyl, Breyanzi, Carvykti, Kymriah, Tecartus, Yescarta) to verify medical necessity criteria are met before claim submission. Update billing system to flag CAR-T claims requiring verification against corresponding drug-specific policies. Ensure all CPT codes (38225-38228), HCPCS codes (Q2041-Q2058), and ICD-10-PCS codes (XW033/XW043 series) are properly mapped in billing software. Train billing staff that coverage determinations for CAR-T therapy depend on meeting criteria in the individual drug policies, not this umbrella policy alone. Failure to verify against drug-specific policies will result in claim denials for medical necessity.