CurrentHumanaPolicy LAB2023003

Oral Screening Lesion Identification Systems (Laboratory)

Humana Medicare Advantage payment policy governing reimbursement for oral screening lesion identification systems and related laboratory tests, specifying non-reimbursable codes and referencing applicable LCDs and MolDX guidance; intended for providers submitting claims for Humana Medicare Advantage members.

Policy Summary

PayerHumana

PolicyOral Screening Lesion Identification Systems (Laboratory)

Policy CodePolicy LAB2023003

Change TypeNo material change

Effective Date03/2023

Next Review Date

Key ActionDo not bill or expect reimbursement for CPT 87623 or CPT 0296U for Humana Medicare Advantage members.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Not reimbursable codes

LAB2023003Policy ID

Medicare AdvantagePlan type

Coverage stance and references

Coverage criteria and references

Humana Medicare Advantage coverage stance and references to applicable Original Local Coverage Determinations (LCDs) and MolDX policies.

Covered when ALL of the following are met:

CPT 87623 (low-risk HPV testing) is not reimbursable for Medicare Advantage members under this policy.

See applicable MolDX and LCD references for procedure-specific guidance.

CPT 0296U (gene expression profiling by RNA sequencing for oral and/or oropharyngeal cancer; e.g., mRNA CancerDetect™) is not reimbursable for Medicare Advantage members under this policy.

See applicable MolDX and LCD references for procedure-specific guidance.

References

Policy Summary

PayerHumana

PolicyOral Screening Lesion Identification Systems (Laboratory)

Policy CodePolicy LAB2023003

Change TypeNo material change

Effective Date03/2023

Next Review Date

Key ActionDo not bill or expect reimbursement for CPT 87623 or CPT 0296U for Humana Medicare Advantage members.

SourceLink

On This Page

Codes and coding guidance

Explicitly non-reimbursable codesCPTNot Covered

87623	Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44)
0296U	Oncology (oral and/or oropharyngeal cancer), gene expression profiling by RNA sequencing at least 20 molecular features (eg, human and/or microbial mRNA), saliva, algorithm reported as positive or negative for signature associated with malignancy (Proprietary test: mRNA CancerDetect™, Lab/Manufacturer: Viome Life Sciences, Inc)

Billing and provider guidance

Prior Authorization

Do not bill for CPT 87623 — low‑risk HPV testing

CPT 87623 (low‑risk HPV testing) is not reimbursable for Humana Medicare Advantage members under this policy. Claims for this procedure should not be expected to receive payment from Humana Medicare Advantage.

Code: 87623 — Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low‑risk types (e.g., 6, 11, 42, 43, 44).

Key definitions and policy scope

inv-04: Medicare Advantage Payment Policy — scope note that this payment policy is developed for Medicare Advantage plans

ScopeThis payment policy was developed for Medicare Advantage plans; criteria apply to Medicare Advantage plans except when procedure-specific criteria are established through Original Local Coverage Determinations (LCDs).

ApplicationApplies to claims submitted for Humana Medicare Advantage members and is intended as guidance for providers submitting claims; claims remain subject to plan requirements, medical necessity, and authorization rules.

Document identifiersPolicy number: LAB2023003; Published: 03/2023; Revision/Last review: 07/2025.

inv-05: Low risk HPV testing (CPT 87623) — definition and designation as not reimbursable

DefinitionTesting for low‑risk HPV types (e.g., 6, 11, 42, 43, 44) using nucleic acid detection methods (CPT 87623).

CodingCPT 87623 — Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low‑risk types.

Reimbursement stanceNot reimbursable for Medicare Advantage members under this policy.

Claims considerationsClaims are subject to other plan requirements, including medical necessity, reasonableness, and applicable referral or authorization requirements.

inv-06: Gene expression profiling by RNA sequencing (CPT 0296U) — definition and non-reimbursable designation (saliva-based RNA sequencing panel example)

DefinitionGene expression profiling by RNA sequencing of saliva with at least 20 molecular features (human and/or microbial mRNA) reported by an algorithm as a signature associated with malignancy (CPT 0296U).

CodingCPT 0296U — Oncology (oral and/or oropharyngeal cancer), gene expression profiling by RNA sequencing (≥20 molecular features), saliva; algorithm reported as positive or negative for malignancy signature (Proprietary test: mRNA CancerDetect™).

Laboratory exampleProprietary test referenced: mRNA CancerDetect™; Lab/Manufacturer: Viome Life Sciences, Inc.

Reimbursement stanceNot reimbursable for Medicare Advantage members under this policy.