Humana is publishing its medical claims payment policies online as an avenue of transparency for health care providers and their billing offices. This information about reimbursement methodologies and acceptable billing practices may help health care providers bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
DME for Indiana PathWays for Aging Medicaid Program (New)
This Indiana Medicaid policy outlines Humana’s billing requirements and reimbursement for durable medical equipment (DME) and home medical equipment (HME) for Indiana PathWays for Aging Medicaid program.
Published Date: 7/9/2025
Chiropractic Services for Acute Treatment
This Medicare Advantage policy establishes Humana’s billing requirements and reimbursement guidelines for chiropractic services covered under the Medicare Part B benefit.
Published Date: 12/16/2024
Laboratory - Diabetes Mellitus Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diabetes mellitus testing.
Published Date: 11/11/2024
Facility and Non-Facility NA Indicator
This Kentucky Medicaid policy outlines Humana’s reimbursement of professional claims for services identified with “NA” in either the facility NA indicator field or the non-facility NA indicator field of the Medicare Physician Fee Schedule (MPFS) Relative Value File.
Published Date: 9/18/2024
Dental Services Inextricably Linked to Medical Services
This Medicare Advantage policy establishes Humana’s billing requirements and reimbursement for dental services that are inextricably linked to the clinical success of a covered medical service.
Published Date: 9/3/2024
Long-Acting Reversible Contraception While Inpatient Postpartum
This Kentucky Medicaid policy outlines Humana’s reimbursement for long-acting reversible contraception (LARC) provided to a postpartum inpatient.
Published Date: 7/11/2024
Self-Administered Drugs While Outpatient in a Hospital
This Medicare Advantage policy outlines Humana’s billing requirements and reimbursement for self-administered drugs, including biologicals, furnished by a hospital to a patient during an outpatient hospital encounter.
Published Date: 6/19/2024
Multiple Evaluation and Management (EM) Services
This Kentucky Medicaid policy outlines Humana’s billing requirements and reimbursement for multiple evaluation and management (E/M) services performed on the same day by the same provider.
Published Date: 6/18/2024
Status B Codes
This Kentucky Medicaid policy outlines Humana’s reimbursement for status B codes.
Published Date: 6/18/2024
Z-Code Billing for Molecular Diagnostic Testing
This Medicare Advantage policy establishes Humana’s requirements for Z-Code® billing for molecular diagnostic testing.
Published Date: 5/2/2024
Paper Check Transaction Fee
This Medicare Advantage policy establishes Humana’s transaction fee for paper checks.
Published Date: 4/4/2024
Reimbursement Level of Certain Evaluation and Management (E/M) Services
This Medicare Advantage policy establishes Humana's reimbursement for certain higher-level evaluation and management (E/M) services.
Published Date: 4/4/2024
Transition Period Billing for an Active Course of Treatment
This Medicare Advantage policy outlines elements used to bill for services furnished, during a Humana MA member’s transition period, as part of an active course of treatment that began before the member’s enrollment in the plan.
Published Date: 11/16/2023
Payment Window for Outpatient Services Treated as Inpatient Services
This Medicare Advantage and commercial policy outlines Humana’s reimbursement for claims subject to the payment window for outpatient services treated as inpatient services.
Published Date: 9/7/2023
Ambulance Services
This Medicare Advantage and commercial policy establishes Humana’s billing requirements and reimbursement for ambulance services.
Published Date: 9/1/2023
Laboratory - Diagnosis of Idiopathic Environmental Intolerance
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnosis of idiopathic environmental intolerance testing.
Published Date: 7/6/2023
Laboratory - Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for fecal analysis in the diagnosis of intestinal dysbiosis and fecal microbiota transplant testing.
Published Date: 7/6/2023
Laboratory - General Inflammation Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for general inflammation testing.
Published Date: 7/6/2023
Laboratory - HIV Genotyping and Phenotyping
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for HIV genotyping and phenotyping testing.
Published Date: 7/6/2023
Laboratory - Identification of Select Microorganisms by Nucleic Probes (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for identification of select microorganisms by nucleic probes.
Published Date: 7/6/2023
Laboratory - Nerve Fiber Density Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for nerve fiber density testing.
Published Date: 7/6/2023
Laboratory - Onychomycosis Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for onychomycosis testing.
Published Date: 7/6/2023
Laboratory - Parathyroid Hormone, Phosphorus, Calcium and Magnesium Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for parathyroid hormone, phosphorus, calcium and magnesium testing.
Published Date: 7/6/2023
Laboratory - Serum Tumor Markers for Malignancies
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for serum tumor markers for malignancies testing.
Published Date: 7/6/2023
Laboratory - Testing for Alpha1 Anti-trypsin Deficiency (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for testing for alpha1 anti-trypsin deficiency.
Published Date: 7/6/2023
Laboratory - Testing for Crohns Disease, Ulcerative Colitis and Irritable Bowel Syndrome (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for testing for Crohn’s disease, ulcerative colitis and irritable bowel syndrome.
Published Date: 7/6/2023
Laboratory - Testing for Mosquito or Tick-Related Infections
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing for mosquito or tick-related infections.
Published Date: 7/6/2023
Laboratory - Testing of Homocysteine Metabolism-Related Conditions
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing of homocysteine metabolism-related conditions.
Published Date: 7/6/2023
Laboratory - Urinary Tumor Markers for Bladder Cancer
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for urinary tumor markers for bladder cancer.
Published Date: 7/6/2023
Laboratory - Urine Culture Testing for Bacteria (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for urine culture testing for bacteria.
Published Date: 7/6/2023
Implantable Devices
This Medicare Advantage and commercial policy outlines Humana's criteria for items that are reimbursable as implantable devices
Published Date: 7/5/2023
Laboratory - Lyme Disease
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for Lyme disease testing.
Published Date: 6/1/2023
Laboratory - B-Hemolytic Streptococcus Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for B-hemolytic streptococcus testing.
Published Date: 5/31/2023
Laboratory - Biochemical Markers of Alzheimers Disease and Dementia (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for biochemical markers of Alzheimer’s disease and dementia.
Published Date: 5/31/2023
Laboratory - Biomarker Testing for Autoimmune Rheumatic Disease (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for biomarker testing for autoimmune rheumatic disease.
Published Date: 5/31/2023
Laboratory - Bone Turnover Markers Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for bone turnover markers testing.
Published Date: 5/31/2023
Laboratory - Cardiovascular Disease Risk Assessment in Adults (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for cardiovascular disease risk assessment in adults.
Published Date: 5/31/2023
Laboratory - Diagnosis of Vaginitis Including Multitarget PCR Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnosis of vaginitis including multi-target PCR testing.
Published Date: 5/31/2023
Laboratory - Diagnostic Testing of Influenza (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for diagnostic testing of influenza.
Published Date: 5/31/2023
Laboratory - Epithelial Cell Cytology in Breast Cancer Risk Assessment (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for epithelial cell cytology in breast cancer risk assessment.
Published Date: 5/31/2023
Laboratory - Intracellular Micronutrient Analysis
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for intracellular micronutrient analysis.
Published Date: 5/31/2023
Laboratory - Prescription Medication and Illicit Drug Testing in the Outpatient Setting
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for prescription medication and illicit drug testing.
Published Date: 5/31/2023
Laboratory - Diagnostic Testing of Iron Homeostasis & Metabolism
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for diagnostic testing of iron homeostasis.
Published Date: 5/2/2023
Laboratory - Folate Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for folate testing.
Published Date: 5/2/2023
Laboratory - Hemoglobin A1c
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for hemoglobin A1c testing.
Published Date: 5/2/2023
Laboratory - Prostate Biopsies (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for prostate biopsies.
Published Date: 5/2/2023
Laboratory - Thyroid Disease Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for thyroid disease testing.
Published Date: 5/2/2023
Laboratory - Allergen Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for allergen testing.
Published Date: 4/6/2023
Laboratory - Helicobacter Pylori Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for helicobacter pylori testing.
Published Date: 4/6/2023
Laboratory - Immune Cell Function Assay
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for immune cell function assays.
Published Date: 4/6/2023
Laboratory - In Vitro Chemo-resistance and Chemo-sensitivities Assay (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for in vitro chemo-resistance and chemo-sensitivities assay.
Published Date: 4/6/2023
Laboratory - Pancreatic Enzyme Testing for Acute Pancreatitis (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for pancreatic enzyme testing for acute pancreatitis.
Published Date: 4/6/2023
Laboratory - Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for serum biomarker testing for multiple sclerosis and related neurologic diseases.
Published Date: 4/6/2023
Laboratory - Testing for Diagnosis of Active or Latent Tuberculosis (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for testing for diagnosis of active or latent tuberculosis.
Published Date: 4/6/2023
Laboratory - Biomarkers for Myocardial Infarction and Chronic Heart Failure (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for biomarkers for myocardial infarction and chronic heart failure.
Published Date: 2/28/2023
Laboratory - Hepatitis Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for hepatitis testing.
Published Date: 2/28/2023
Laboratory - Oral Screening Lesion Identification Systems (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for oral screening lesion identification systems.
Published Date: 2/28/2023
Laboratory - Prostate Specific Antigen (PSA) Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for prostate specific antigen testing.
Published Date: 2/28/2023
Laboratory - Testosterone Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for testosterone testing.
Published Date: 2/28/2023
Laboratory - Venous and Arterial Thrombosis Testing (Revised)
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for venous and arterial thrombosis testing.
Published Date: 2/28/2023
Laboratory - Vitamin B12 Testing
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for vitamin B12 testing.
Published Date: 2/28/2023
Outpatient Claim Itemized Bill Review
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on outpatient claim itemized bill reviews.
Published Date: 2/8/2023
Cost-Sharing for Cost-Share Protected Members
This Medicare Advantage, commercial and Medicaid policy establishes Humana's expectations regarding cost-sharing for cost-share protected members.
Published Date: 12/2/2022
Automobile and Workplace Injuries
This Medicare Advantage and Medicaid policy outlines Humana’s billing requirements and reimbursement for claims for healthcare services provided due to automobile and workplace injuries.
Published Date: 6/1/2022
Neonatal Intensive Care Unit (NICU) Guidelines (Revised)
This Kentucky Medicaid and Oklahoma Medicaid policy outlines Humana’s billing requirements and reimbursement for NICU claims.
Published Date: 4/29/2022
Opioid Treatment Program
This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for Opioid Treatment Programs (OTPs).
Published Date: 8/27/2021
Anesthesia Services
This Medicare Advantage and commercial policy establishes Humana's billing requirements and reimbursement for anesthesia services.
Published Date: 8/20/2021
Physician Administered Drugs
This Kentucky Medicaid policy outlines how Humana establishes rates for Physician Administered Drug codes that do not have rates in the Kentucky Medicaid fee schedule.
Published Date: 4/20/2021
Acupuncture for Chronic Lower Back Pain (Revised)
This Medicare Advantage policy establishes Humana’s billing requirements regarding the Medicare Part B benefit for acupuncture for chronic lower back pain (cLBP).
Published Date: 2/19/2021
Home Health Request for Anticipated Payment (RAP) and Notice of Admission (NOA)
This Medicare Advantage and commercial policy establishes Humana's billing and reimbursement guidelines for RAP and NOA submissions.
Published Date: 1/21/2021
COVID-19 Monoclonal Antibodies
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s billing expectations for COVID-19 monoclonal antibody claims, specifically charges both for COVID-19 monoclonal antibody products and for the administration of those products.
Published Date: 1/15/2021
COVID-19 Vaccine
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s billing expectations and reimbursement for COVID-19 vaccine claims, which refers to charges for the SARS-CoV-2 vaccine
Published Date: 12/23/2020
Additional Supplies, Materials and Staff Time for Services Performed During a Respiratory-Transmitted Infectious Disease Public Health Emergency
This Medicare Advantage and commercial policy outlines how Humana adjudicates a charge for CPT code 99072. This code reports additional supplies, materials and staff time for services performed during a Public Health Emergency that has been declared due to a respiratory-transmitted infectious disease.
Published Date: 12/8/2020
Claims Reporting Standards
This Medicare Advantage and commercial policy outlines Humana’s expectation for reporting codes and other data on claims billed to Humana plans.
Published Date: 11/5/2020
COVID-19 Related Coding
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s billing expectations for COVID-19 related claims.
Published Date: 7/30/2020
Telehealth and Other Virtual Services During the COVID-19 PHE
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s billing expectations and reimbursement for telehealth and other virtual services rendered during the COVID-19 public health emergency, which ended May 11, 2023.
Published Date: 4/9/2020
Inpatient Readmission Review
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s inpatient readmission review standards.
Published Date: 1/16/2020
Modifiers CO and CQ
This Medicare Advantage and commercial policy establishes Humana’s billing requirements and reimbursement for outpatient occupational and physical therapy assistant services and the proper use of modifiers CO and CQ.
Published Date: 12/10/2019
Missed Appointments
This Medicare Advantage and commercial policy establishes Humana’s policy on billing members for missed appointments.
Published Date: 8/2/2019
Electronic Transactions (Revised)
This Medicare Advantage and Medicaid policy establishes Humana’s policy on electronic transactions.
Published Date: 6/19/2019
Observation Services
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s requirments for billing and documentation of observation services.
Published Date: 4/2/2019
DME Repair and Replacement
This Medicare Advantage and commercial policy establishes how Humana plans reimburse the repair and replacement of durable medical equipment base items, parts and accessories.
Published Date: 12/14/2018
Telehealth and Other Virtual Services (Revised)
This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse charges for telehealth and other virtual services. This includes services rendered after the ending of the COVID-19 public health emergency on May 11, 2023.
Published Date: 6/26/2018
Emergency Department E/M Reimbursement (Revised)
This Medicare Advantage, Kentucky Medicaid and Oklahoma Medicaid policy outlines the criteria Humana plans use to determine the level of reimbursement for facility E/M services provided in the emergency department.
Published Date: 4/4/2018
Modifiers JW and JZ
This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for a charge reported with modifier JW or JZ.
Published Date: 9/25/2017
Modifier FX
This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse a charge reported with modifier FX.
Published Date: 8/29/2017
Modifier FY
This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse a charge reported with modifier FY.
Published Date: 8/29/2017
Multiple Procedure Payment Reduction
This Medicare Advantage and commercial policy establishes how Humana plans apply multiple procedure payment reductions.
Published Date: 3/29/2017
Ordering Referring Provider Requirements
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s ordering and referring requirements for health care providers.
Published Date: 3/29/2017
Modifier CT
This Medicare Advantage, commercial and Medicaid policy details the use of modifier CT for computed tomography services furnished on equipment that is not consistent with dose optimization standards established by the National Electrical Manufacturers Association.
Published Date: 12/19/2016
Claim Disputes
This Medicare Advantage, commercial and Medicaid policy establishes the timeframes to submit a dispute request from a qualified healthcare provider.
Published Date: 11/30/2016
Modifier 53
This Medicare Advantage, commercial, Medicaid and Kentucky Medicaid policy establishes how Humana plans reimburse charges if a physician terminates a surgical or diagnostic procedure because of extenuating circumstances or those that may threaten the well-being of a patient.
Published Date: 9/30/2016
Gender Specific Services for Transgender or Intersex Members
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges gender specific services for transgender or intersex members.
Published Date: 8/30/2016
DMEPOS Proof of Delivery Documentation
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on proof of delivery for DMEPOS items.
Published Date: 7/18/2016
Itemized Bill Review for Inpatient Routine Services
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on itemized bill review for inpatient routine services.
Published Date: 6/24/2016
Inpatient to Outpatient Rebilling
This Medicare Advantage and commercial policy establishes how Humana plans reimburse inpatient to outpatient rebilling.
Published Date: 6/16/2016
Transitional Care Management
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for transitional care management.
Published Date: 5/11/2016
Pass-through Billing
This Medicare Advantage and commercial policy establishes how Humana plans reimburse pass-through billing charges.
Published Date: 2/25/2016
Modifier 78 (Revised)
This Medicare Advantage, Kentucky Medicaid and Oklahoma Medicaid policy establishes how Humana plans reimburse charges for an unplanned return to the operating/procedure room.
Published Date: 12/31/2015
Chronic Care Management and Principal Care Management
This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for chronic care management and principal care management.
Published Date: 3/31/2015
Initial Preventive Physical Examination and Annual Wellness Visit
This Medicare Advantage policy establishes how Humana plans reimburse charges for initial preventive physical examinations and annual wellness visits.
Published Date: 3/24/2015
Medicare Opt-Out
This Medicare Advantage policy establishes Humana’s policy on Medicare opt out that allows some physicians and practitioners to opt out of the Medicare Program.
Published Date: 3/9/2015
National Drug Code Billing Requirement (Revised)
This Medicare Advantage and Medicaid policy establishes Humana’s NDC billing requirement.
Published Date: 2/25/2015
Common CPT and HCPCS Modifiers
A list of commonly used CPT and HCPCS modifiers, and a high-level presentation of how those modifiers are generally used for reimbursement.
Published Date: 2/3/2015
Modifiers X{EPSU}
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges that include modifiers XE, XP, XS or XU, collectively known as modifiers X{EPSU}.
Published Date: 1/14/2015
Radiation Therapy Management - CPT code 77427
This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for CPT code 77427.
Published Date: 12/24/2014
Assistant at Surgery Reimbursement
This Medicare Advantage and commercial policy establishes Humana’s assistant at surgery reimbursement policy.
Published Date: 12/12/2014
Modifier 52
This Medicare Advantage, commercial and Kentucky Medicaid policy establishes how Humana plans reimburse charges if a procedure is partially reduced, or if the procedure is discontinued either before anesthesia is administered or if anesthesia is not planned.
Published Date: 10/13/2014
Modifier EY
This Medicare Advantage and commercial policy establishes how Humana plans reimburse a charge reported with modifier EY.
Published Date: 9/19/2014
Screening Colonoscopy
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for a screening colonoscopy.
Published Date: 9/19/2014
Increased Procedural Services/Modifier 22
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for increased procedural services.
Published Date: 7/1/2014
Itemized Bill
This Medicare Advantage and commercial policy outlines Humana’s expectation that an itemized bill be made available upon request.
Published Date: 7/1/2014
DME Capped Rental
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for DME capped rental items.
Published Date: 6/20/2014
DME Inexpensive or Routinely Purchased
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for “inexpensive” and “other routinely purchased” DME items.
Published Date: 6/20/2014
DME Oxygen
This Medicare Advantage and commercial policy establishes how Humana reimburses charges for durable medical equipment (DME) for oxygen equipment, contents, supplies and other oxygen-related services.
Published Date: 6/20/2014
DME Transcutaneous Electrical Nerve Stimulator
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges a transcutaneous electrical nerve stimulator (TENS) device.
Published Date: 6/20/2014
Modifier 50
This Medicare Advantage and commercial policy describes Humana’s policy on correct billing practices for modifier 50 and bilateral procedures that are performed at the same operative session.
Published Date: 6/20/2014
Modifier 62
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for co-sugeons.
Published Date: 6/20/2014
Modifiers 54 55 and 56
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for split global care modifiers 54, 55 and 56.
Published Date: 6/20/2014
Medical claims payment policy disclaimer
The intended audience of these medical claims payment policies is healthcare providers who treat Humana members. These policies are made available to provide information on certain Humana claims payment processes. These policies are guidelines only and do not constitute a benefit determination, medical advice, guarantee of payment, plan preauthorization, an Explanation of Benefits or a contract. These policies are not intended to address every claim situation. Whether a procedure is covered shall be determined based on the terms and provisions of a specific member plan or policy. Claims may be affected by other factors, such as state and federal laws and regulations, provider contract terms and our professional judgment. These policies are subject to change or termination by Humana. Humana has full and final discretionary authority for their interpretation and application.