Humana Imposes Further Restrictions on Medicare Coverage for Neuromodulation Therapies

Open enrollment for Medicare Advantage runs October 15 - December 7. If you see Medicare patients, encourage them to review all their options when considering which type of Medicare plan they want. If they are looking at Medicare Advantage plans, they need to know that all plans are not the same.
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Physicians should be aware that Humana’s Medicare Advantage plan has some of the most rigorous and strict prior authorization requirements when it comes to neuromodulation therapies like spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS).

Recently, for a patient to qualify for spinal cord stimulation coverage, Humana added more restrictions—more than what we see typically with the Medicare National Coverage Decision (NCD):
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• 7-day minimum SCS trial
• Limiting SCS coverage to FBSS, CRPS, and DPN
• Physical therapy for FBSS and CRPS
• Surgery consult for FBSS

​Humana’s restrictive policies have resulted in limited beneficiary access to these therapies that would have been available to them under Traditional Medicare.
 
Information to share with your patients
The annual Medicare open enrollment period runs October 15 through December 7, 2024. During this time, people with Medicare should review features of Medicare plans offered in their area and are able to change their Medicare coverage, which would go into effect on January 1, 2025.

Medicare beneficiaries should compare their current source of Medicare coverage during the annual open enrollment period with other options that are available to them. Because medical needs can change over the course of the year, and from one year to the next, this may influence which plan a Medicare beneficiary chooses and how they want to get their Medicare benefits.

People who are enrolled in a Medicare Advantage plan can use the Medicare open enrollment period to choose a different Medicare Advantage plan or switch to traditional Medicare. Medicare Advantage enrollees who switch to traditional Medicare can enroll in a Part D plan if they want outpatient prescription drug coverage, which is not covered under Medicare Parts A and B.

Traditional Medicare and Medicare Advantage both provide coverage of all services included in Medicare Part A and Part B, but certain features, such as out-of-pocket costs, provider networks, access to extra benefits and rules related to prior authorization and referral requirements can vary significantly between these two types of Medicare coverage.
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For more information on the choices available to Medicare beneficiaries, please review the 2025 handbook. 

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