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Liquid Biopsy - Medicare Advantage (Revised)

Humana·IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, NY, ME, MA, NH, RI, VT, KY, OH, CA, HI, NV, AS, GU, MP, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, NM, OK, TX, LA, MS, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR, VI · Oncology, Hematology, Pulmonology +2 more·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Aug 4, 2026
Days to comply
—

Summary

Humana Medicare Advantage has updated its Liquid Biopsy coverage policy (Policy HUM-1151-014), effective 08/03/2026. This policy establishes coverage criteria for liquid biopsy tests (blood-based biomarker analysis for cancer detection and treatment monitoring) across multiple jurisdictions under Medicare Administrative Contractors. The policy requires medical necessity documentation and adherence to MAC-specific Local Coverage Determinations, with coverage determined through analytical/clinical validity standards and DEX Registry evaluation where CMS guidance is absent.

Action Required

Action needed
By August 3, 2026: Billing team must review and update billing workflows to align with this policy revision. (1) Verify which MAC jurisdiction(s) your practice operates under (J5, J8, J6, JK, J15, JE, JF, JH, JL, JJ, JM, or JN as listed in policy) and obtain the corresponding LCD/LCA documents for liquid biopsy tests. (2) Update claim submission guidelines to include proper medical necessity documentation for all liquid biopsy tests (circulating tumor DNA, circulating tumor cells, and biomarker analyses). (3) Establish prior authorization protocols where required by the applicable MAC jurisdiction. (4) Train billing and clinical staff on coverage criteria including analytical validity, clinical validity, and clinical utility requirements. (5) Update EMR/billing system to flag liquid biopsy claims for verification against MAC-specific coverage limitations. (6) Do NOT process liquid biopsy claims without confirming coverage under the applicable regional MAC LCD/LCA. Non-compliant claims will be denied.

Related policy hubs

Humana policiesIA policy changesKS policy changesMO policy changesNE policy changesIN policy changesMI policy changesIL policy changesMN policy changesWI policy changesCT policy changesNY policy changesME policy changesMA policy changesNH policy changesRI policy changesVT policy changesKY policy changesOH policy changesCA policy changesHI policy changesNV policy changesAS policy changesGU policy changesMP policy changesAK policy changesAZ policy changesID policy changesMT policy changesND policy changesOR policy changesSD policy changesUT policy changesWA policy changesWY policy changesAR policy changesCO policy changesNM policy changesOK policy changesTX policy changesLA policy changesMS policy changesDE policy changesDC policy changesMD policy changesNJ policy changesPA policy changesAL policy changesGA policy changesTN policy changesNC policy changesSC policy changesVA policy changesWV policy changesFL policy changesPR policy changesVI policy changesOncologyHematologyPulmonologyPathologyInternal Medicine