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Humana is publishing its medical claims payment policies online as a new 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.

Chiropractic Services for Acute Treatment(New)

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

DME for Indiana Medicaid(New)

This Indiana Medicaid policy outlines Humana’s billing requirements and reimbursement for durable medical equipment (DME) and home medical equipment (HME).
Published Date: 12/02/2024

Laboratory - Diabetes Mellitus Testing(New)

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(New)

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: 09/18/2024

Dental Services Inextricably Linked to Medical Services(Revised)

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: 09/04/2024

Long-Acting Reversible Contraception While Inpatient Postpartum(New)

This Kentucky Medicaid policy outlines Humana’s reimbursement for long-acting reversible contraception (LARC) provided to a postpartum inpatient.
Published Date: 07/11/2024

Self-Administered Drugs While Outpatient in a Hospital(New)

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: 06/19/2024

Multiple Evaluation and Management (EM) Services(New)

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: 06/18/2024

Status B Codes(New)

This Kentucky Medicaid policy outlines Humana’s reimbursement for status B codes.
Published Date: 06/18/2024

Z-Code Billing for Molecular Diagnostic Testing(New)

This Medicare Advantage (MA) policy establishes Humana’s requirements for Z-Code® billing for molecular diagnostic testing.
Published Date: 05/02/2024

Paper Check Transaction Fee(New)

This Medicare Advantage (MA) policy establishes Humana’s transaction fee for paper checks.
Published Date: 04/04/2024

Reimbursement Level of Certain Evaluation and Management (E/M) Services(New)

This Medicare Advantage (MA) policy establishes Humana's reimbursement for certain higher-level evaluation and management (E/M) services.
Published Date: 04/04/2024

Transition Period Billing for an Active Course of Treatment

This Medicare Advantage (MA) 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: 09/07/2023

Ambulance Services

This Medicare Advantage and commercial policy establishes Humana’s billing requirements and reimbursement for ambulance services.
Published Date: 09/01/2023

Laboratory - Diagnosis of Idiopathic Environmental Intolerance(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnosis of idiopathic environmental intolerance testing.
Published Date: 07/06/2023

Laboratory - Fecal Analysis in the Diagnosis of Intestinal Dysbiosis(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for fecal analysis in the diagnosis of intestinal dysbiosis.
Published Date: 07/06/2023

Laboratory - General Inflammation Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for general inflammation testing.
Published Date: 07/06/2023

Laboratory - HIV Genotyping and Phenotyping(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for HIV genotyping and phenotyping testing.
Published Date: 07/06/2023

Laboratory - Identification of Select Micro-organisms by Nucleic Probes(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for identification of select micro-organisms by nucleic probes.
Published Date: 07/06/2023

Laboratory - Lab Testing for Crohns Disease, UC and IBS(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for lab testing for Crohn’s disease, ulcerative colitis, and irritable bowel syndrome.
Published Date: 07/06/2023

Laboratory - Nerve Fiber Density Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for nerve fiber density testing.
Published Date: 07/06/2023

Laboratory - Onychomycosis Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for onychomycosis testing.
Published Date: 07/06/2023

Laboratory - Parathyroid Hormone, Phosphorus, Calcium and Magnesium Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for parathyroid hormone, phosphorus, calcium and magnesium testing.
Published Date: 07/06/2023

Laboratory - Serum Tumor Markers for Malignancies(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for serum tumor markers for malignancies testing.
Published Date: 07/06/2023

Laboratory - Testing for Alpha1 Anti-trypsin Deficiency(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing for alpha1 anti-trypsin deficiency.
Published Date: 07/06/2023

Laboratory - Testing for Mosquito or Tick-Related Infections(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing for mosquito or tick-related infections.
Published Date: 07/06/2023

Laboratory - Testing of Homocysteine Metabolism-Related Conditions(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing of homocysteine metabolism-related conditions.
Published Date: 07/06/2023

Laboratory - Urinary Tumor Markers for Bladder Cancer(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for urinary tumor markers for bladder cancer.
Published Date: 07/06/2023

Laboratory - Urine Culture Testing for Bacteria(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for urine culture testing for bacteria.
Published Date: 07/06/2023

Implantable Devices

This Medicare Advantage and commercial policy outlines Humana's criteria for items that are reimbursable as implantable devices.
Published Date: 07/05/2023

Laboratory - Lyme Disease(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for Lyme disease testing.
Published Date: 06/01/2023

Laboratory - Antinuclear Antibodies (ANA)/Extractable Nuclear Antigen (ENA) Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for ANA ENA testing.
Published Date: 05/31/2023

Laboratory - B-Hemolytic Streptococcus Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for B-hemolytic streptococcus testing.
Published Date: 05/31/2023

Laboratory - Biochemical Markers of Alzheimers Disease and Dementia(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for biochemical markers of Alzheimer’s disease and dementia testing.
Published Date: 05/31/2023

Laboratory - Bone Turnover Markers Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for bone turnover markers testing.
Published Date: 05/31/2023

Laboratory - Cardiovascular Disease Risk Assessment in Adults(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for cardiovascular disease risk assessment in adults.
Published Date: 05/31/2023

Laboratory - Diagnosis of Vaginitis Including Multitarget PCR Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnosis of vaginitis including multi-target PCR testing.
Published Date: 05/31/2023

Laboratory - Diagnostic Testing of Influenza(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnostic Testing of influenza.
Published Date: 05/31/2023

Laboratory - Epithelial Cell Cytology in Breast Cancer Risk Assessment(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for epithelial cell cytology in breast cancer risk assessment.
Published Date: 05/31/2023

Laboratory - Evaluation of Dry Eyes

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for evaluation of dry eyes.
Published Date: 05/31/2023

Laboratory - Fecal Calprotectin Testing in Adults

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for evaluation of fecal calprotectin testing in adults.
Published Date: 05/31/2023

Laboratory - Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for immunopharmacologic monitoring of therapeutic serum antibodies.
Published Date: 05/31/2023

Laboratory - Intracellular Micronutrient Analysis(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for intracellular micronutrient analysis.
Published Date: 05/31/2023

Laboratory - Prescription Medication and Illicit Drug Testing in the Outpatient Setting(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for prescription medication and illicit drug testing.
Published Date: 05/31/2023

Laboratory - ST2 Assay for Chronic Heart Failure

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for ST2 assay for chronic heart failure testing.
Published Date: 05/31/2023

Laboratory - Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for serum testing for hepatic fibrosis.
Published Date: 05/31/2023

Laboratory - Diagnostic Testing of Iron Homeostasis & Metabolism(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for diagnostic testing of iron homeostasis.
Published Date: 05/02/2023

Laboratory - Folate Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for folate testing.
Published Date: 05/02/2023

Laboratory - Hemoglobin A1c

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for hemoglobin A1c testing.
Published Date: 05/02/2023

Laboratory - Pathogen Panel Testing

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for pathogen panel testing.
Published Date: 05/02/2023

Laboratory - Prostate Biopsies(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for prostate biopsy testing.
Published Date: 05/02/2023

Laboratory - Thyroid Disease Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for thyroid disease testing.
Published Date: 05/02/2023

Laboratory - Vitamin D

This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for vitamin D testing.
Published Date: 05/02/2023

Laboratory - Allergen Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for allergen testing.
Published Date: 04/06/2023

Laboratory - Flow Cytometry(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for flow cytometry.
Published Date: 04/06/2023

Laboratory - Helicobacter Pylori Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for helicobacter pylori testing.
Published Date: 04/06/2023

Laboratory - Immune Cell Function Assay(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for immune cell function assays.
Published Date: 04/06/2023

Laboratory - In Vitro Chemo-resistance and Chemo-sensitivities Assay(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for immune cell function assays.
Published Date: 04/06/2023

Laboratory - Measurement of Thromboxane Metabolites(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for the measurement of thromboxane metabolites.
Published Date: 04/06/2023

Laboratory - Pancreatic Enzyme Testing for Acute Pancreatitis(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for pancreatic enzyme testing for acute pancreatitis.
Published Date: 04/06/2023

Laboratory - Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for serum biomarker testing for multiple sclerosis.
Published Date: 04/06/2023

Laboratory - Testing for Diagnosis of Active or Latent Tuberculosis(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for testing for a diagnosis of active or latent tuberculosis.
Published Date: 04/06/2023

Laboratory - Cardiac Biomarkers for Myocardial Infarction(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for cardiac biomarkers for myocardial infarction.
Published Date: 02/28/2023

Laboratory - Hepatitis C(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for hepatitis C testing.
Published Date: 02/28/2023

Laboratory - Oral Screening Lesion Identification System(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for oral screening lesion identification systems.
Published Date: 02/28/2023

Laboratory - Prostate Specific Antigen (PSA) Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for prostate specific antigen testing.
Published Date: 02/28/2023

Laboratory - Testosterone Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for testosterone testing.
Published Date: 02/28/2023

Laboratory - Venous and Arterial Thrombosis Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for venous and arterial thrombosis testing.
Published Date: 02/28/2023

Laboratory - Vitamin B12 Testing(Revised)

This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for vitamin B12 testing.
Published Date: 02/28/2023

Outpatient Claim Itemized Bill Review

This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on outpatient claim itemized bill reviews.
Published Date: 02/08/2023

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: 12/02/2022

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: 06/01/2022

Neonatal Intensive Care Unit (NICU) DRG Guidelines(Revised)

This Kentucky Medicaid policy establishes guidelines for how Humana determines the appropriate NICU DRG code for reimbursement.
Published Date: 04/29/2022

Opioid Treatment Program(Revised)

This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for Opioid Treatment Programs (OTPs).
Published Date: 08/27/2021

Anesthesia Services(Revised)

This Medicare Advantage and commercial policy establishes Humana's billing requirements and reimbursement for anesthesia services.
Published Date: 08/20/2021

State-Supplied Vaccines

This commercial and Medicaid policy outlines Humana’s billing requirements and reimbursement for state-supplied vaccines.
Published Date: 05/14/2021

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: 04/20/2021

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: 02/19/2021

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: 01/21/2021

COVID-19 Monoclonal Antibodies(Revised)

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: 01/15/2021

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: 12/08/2020

Claims Reporting Standards

This policy outlines Humana’s expectation for reporting codes and other data on claims billed to Humana plans.
Published Date: 11/05/2020

COVID-19 Related Coding

This Medicare Advantage, commercial and Medicaid policy outlines Humana’s billing expectations for COVID-19 related claims.
Published Date: 07/30/2020

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: 04/09/2020

Inpatient Readmission Review

This Medicare Advantage, commercial and Medicaid policy outlines Humana’s inpatient readmission review standards.
Published Date: 01/16/2020

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: 08/02/2019

Electronic Transactions (Revised)

This Medicare Advantage and Medicaid policy establishes Humana’s policy on electronic transactions.
Published Date: 06/19/2019

Obstetric Billing

This commercial policy establishes how Humana plans reimburse charges for obstetric billing, including antepartum, delivery and postpartum care.
Published Date: 06/19/2019

Observation Services

This Medicare Advantage, commercial and Medicaid policy establishes Humana’s requirments for billing and documentation of observation services.
Published Date: 04/02/2019

Robotic and Computer Assisted Surgeries

This commercial policy establishes how Humana plans reimburse charges for robotic and computer assisted surgeries.
Published Date: 01/08/2019

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: 06/26/2018

Emergency Department E/M Reimbursement

This Medicare Advantage, commercial and Kentucky 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: 04/04/2018

Modifiers JW and JZ(Revised)

This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for a charge reported with modifier JW or JZ.
Published Date: 09/25/2017

Modifier FX

This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse a charge reported with modifier FX.
Published Date: 08/29/2017

Modifier FY

This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse a charge reported with modifier FY.
Published Date: 08/29/2017

Multiple Procedure Payment Reduction

This Medicare Advantage and commercial policy establishes how Humana plans apply multiple procedure payment reductions.
Published Date: 03/29/2017

Ordering Referring Provider Requirements

This Medicare Advantage, commercial and Medicaid policy establishes Humana’s ordering and referring requirements for health care providers.
Published Date: 03/29/2017

Rehabilitative and Habilitative Services

This commercial policy establishes how Humana plans reimburse charges for rehabilitative and habilitative services.
Published Date: 12/29/2016

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(Revised)

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(Revised)

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: 09/30/2016

Provider-based Clinic Services

This commercial policy establishes how Humana plans reimburse charges for provider-based clinic services.
Published Date: 09/22/2016

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: 08/30/2016

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: 07/18/2016

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: 06/24/2016

Inpatient to Outpatient Rebilling

This Medicare Advantage and commercial policy establishes how Humana plans reimburse inpatient to outpatient rebilling.
Published Date: 06/16/2016

Transitional Care Management(Revised)

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for transitional care management.
Published Date: 05/11/2016

Pass-through Billing

This Medicare Advantage and commercial policy establishes how Humana plans reimburse pass-through billing charges.
Published Date: 02/25/2016

Modifier 78(Revised)

This Medicare Advantage, commercial and Kentucky 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: 03/31/2015

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: 03/24/2015

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: 03/09/2015

National Drug Code Billing Requirement (Revised)

This Medicare Advantage and Medicaid policy establishes Humana’s NDC billing requirement.
Published Date: 02/25/2015

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: 02/03/2015

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: 01/14/2015

Drug Testing

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for drug testing.
Published Date: 12/24/2014

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

Neonatal Intensive Care Unit (NICU) Level of Care Guidelines

This commercial policy establishes guidelines how Humana plans determine the appropriate NICU level of care for reimbursement.
Published Date: 12/01/2014

Modifier 52(Revised)

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: 09/19/2014

Screening Colonoscopy

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for a screening colonoscopy.
Published Date: 09/19/2014

After-Hours Charges

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for after-hours CPT® codes 99050 – 99060.
Published Date: 07/01/2014

Increased Procedural Services/Modifier 22

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for increased procedural services.
Published Date: 07/01/2014

Itemized Bill

This Medicare Advantage and commercial policy outlines Humana’s expectation that an itemized bill be made available upon request.
Published Date: 07/01/2014

DME Capped Rental

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for DME capped rental items.
Published Date: 06/20/2014

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: 06/20/2014

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: 06/20/2014

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: 06/20/2014

Modifier 50(Revised)

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: 06/20/2014

Modifier 62

This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for co-sugeons.
Published Date: 06/20/2014

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: 06/20/2014

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.