Medicare AdvantageCoverageMedium impact
Genetic and Biomarker Testing for Neurodegenerative Disease - Medicare Advantage (Revised)
Humana·Neurology, Neurosurgery, Genetics +2 more·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Aug 4, 2026
Summary
Humana Medicare Advantage updated its policy on genetic and biomarker testing for neurodegenerative diseases (effective 08/03/2026). The policy establishes coverage criteria for testing related to Alzheimer's disease, Parkinson's disease, and other neurodegenerative conditions, with coverage determined by CMS guidance (NCDs/LCDs), MolDX program approval, or FDA approval when used within labeling indications. Billing teams must verify jurisdiction-specific LCD requirements before processing claims for genetic and biomarker tests.
Action Required
By August 3, 2026: Billing team must review the jurisdiction-specific Medicare Administrative Contractor (MAC) guidance for your location using the LCD/LCA table provided in the policy. Update billing systems and prior authorization workflows to require: (1) verification that genetic/biomarker tests for neurodegenerative disease meet CMS LCD criteria, MolDX program approval, or FDA approval within labeled indications; (2) confirmation that tests are ordered by treating physicians for specific medical problems; (3) documentation that medical necessity criteria are met. Providers should be notified to obtain prior authorization as required by their MAC jurisdiction before ordering genetic testing (CSF biomarkers, plasma biomarkers, or genetic panels for conditions like EOFAD, Parkinson's disease, or ALS). Claims submitted without proper authorization or documentation of medical necessity will be denied.