Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage

This Humana Medicare Advantage policy (effective 12/01/2025) covers noninvasive hepatic fibrosis assessment with FIB-4 as a reasonable initial test and allows VCTE/TE and MRE under defined clinical criteria (diagnosis of chronic liver disease, specific FIB-4 thresholds or risk factors, timing/frequency limits, and MRI/iron/availability constraints). The policy excludes real-time SWE, spleen stiffness measurement, ARFI, proprietary serum fibrosis panels, and quantitative MR tissue-composition tests as not medically reasonable and necessary. Documentation of FIB-4 results, chronic liver disease status, prior testing within 6 months, relevant risk factors, and MRI contraindications/iron status (for MRE) is required for coverage.

"Successful testing for hepatic fibrosis (eg, liver biopsy, MRE, VCTE) must not have been performed within the previous 6 months for MRE coverage (timing limitation)."