Medicare AdvantageCoverageMedium impact
Functional Electrical Stimulators (Non-Pain) - Medicare Advantage (Revised)
Humana·Cardiothoracic Surgery, Neurosurgery, Pulmonology +2 more·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Aug 4, 2026
Summary
Humana Medicare Advantage revised its Functional Electrical Stimulators (Non-Pain) policy effective 08/03/2026, establishing coverage criteria for phrenic nerve stimulator adjustments, repairs, replacements, and removals. The policy clarifies that these procedures are medically reasonable and necessary only when the device remains medically necessary or when complications warrant intervention. Billing teams must ensure claims for phrenic nerve procedures (33278-33280, 33281, 33287, 33288) include documentation of medical necessity.
Action Required
By August 3, 2026: Billing team must update claim review processes and prior authorization workflows to require documentation supporting medical necessity for all phrenic nerve stimulator procedures (CPT 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 64575, 93150, 93151, 93152, 93153). For adjustments/repositioning, repair, or replacement claims (33281, 33287, 33288), require provider documentation confirming the device remains medically necessary. For removal claims (33278, 33279, 33280), require documentation that either the medical condition no longer necessitates the device or complications/adverse changes (such as infection, electrode failure, or undesirable stimulation) warrant removal. Update billing software denial rules to reject claims lacking this documentation. Train billing staff and providers on new documentation requirements to prevent claim denials. Reference CMS NCD 160.19 when adjudicating claims.