Laboratory Oral Screening Lesion Identification Systems
Humana's Medicare Advantage payment policy describing the payment stance and applicable limitations for laboratory tests and device-based adjunctive oral lesion screening systems (including specific CPT/HCPCS codes cited) for providers treating Humana Medicare Advantage members.
No material clinical or coverage changes in this revision.
Coverage Criteria and Exclusions
Coverage exclusions and references
Humana indicates non‑reimbursement for specific tests and directs adherence to Original Local Coverage Determinations (LCDs) and contractor policies for applicability.
ALL of the following
- CPT code 87623 is not reimbursable for Medicare Advantage members unless the jurisdiction is governed by an Original LCD/contractor listed below.
Applies to low‑risk HPV testing (Human Papillomavirus types 6,11,42,43,44).
- CPT/HCPCS code 0296U is not reimbursable for Medicare Advantage members unless the jurisdiction is governed by an Original LCD/contractor listed below.
0296U: gene expression profiling by RNA sequencing for oral/oropharyngeal cancer (example: mRNA CancerDetect).
Exception jurisdictions (original LCD/contractor) - ONE of
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