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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.
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
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diabetes mellitus testing.
Published Date: 11/11/2024
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
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
This Kentucky Medicaid policy outlines Humana’s reimbursement for long-acting reversible contraception (LARC) provided to a postpartum inpatient.
Published Date: 07/11/2024
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
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
This Kentucky Medicaid policy outlines Humana’s reimbursement for status B codes.
Published Date: 06/18/2024
This Medicare Advantage (MA) policy establishes Humana’s requirements for Z-Code® billing for molecular diagnostic testing.
Published Date: 05/02/2024
This Medicare Advantage (MA) policy establishes Humana’s transaction fee for paper checks.
Published Date: 04/04/2024
This Medicare Advantage (MA) policy establishes Humana's reimbursement for certain higher-level evaluation and management (E/M) services.
Published Date: 04/04/2024
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
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
This Medicare Advantage and commercial policy establishes Humana’s billing requirements and reimbursement for ambulance services.
Published Date: 09/01/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnosis of idiopathic environmental intolerance testing.
Published Date: 07/06/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for general inflammation testing.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for HIV genotyping and phenotyping testing.
Published Date: 07/06/2023
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
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for nerve fiber density testing.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for onychomycosis testing.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for parathyroid hormone, phosphorus, calcium and magnesium testing.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for serum tumor markers for malignancies testing.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing for alpha1 anti-trypsin deficiency.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing for mosquito or tick-related infections.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for testing of homocysteine metabolism-related conditions.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for urinary tumor markers for bladder cancer.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for urine culture testing for bacteria.
Published Date: 07/06/2023
This Medicare Advantage and commercial policy outlines Humana's criteria for items that are reimbursable as implantable devices.
Published Date: 07/05/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for Lyme disease testing.
Published Date: 06/01/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for ANA ENA testing.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for B-hemolytic streptococcus testing.
Published Date: 05/31/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for bone turnover markers testing.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for cardiovascular disease risk assessment in adults.
Published Date: 05/31/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for diagnostic Testing of influenza.
Published Date: 05/31/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for evaluation of dry eyes.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for evaluation of fecal calprotectin testing in adults.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for immunopharmacologic monitoring of therapeutic serum antibodies.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for intracellular micronutrient analysis.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for prescription medication and illicit drug testing.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for ST2 assay for chronic heart failure testing.
Published Date: 05/31/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for serum testing for hepatic fibrosis.
Published Date: 05/31/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for folate testing.
Published Date: 05/02/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for hemoglobin A1c testing.
Published Date: 05/02/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for pathogen panel testing.
Published Date: 05/02/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for prostate biopsy testing.
Published Date: 05/02/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for thyroid disease testing.
Published Date: 05/02/2023
This Medicare Advantage policy outlines Humana’s reimbursement guidelines for laboratory charges for vitamin D testing.
Published Date: 05/02/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for allergen testing.
Published Date: 04/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for flow cytometry.
Published Date: 04/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for helicobacter pylori testing.
Published Date: 04/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for immune cell function assays.
Published Date: 04/06/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for immune cell function assays.
Published Date: 04/06/2023
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
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
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
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
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for hepatitis C testing.
Published Date: 02/28/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for prostate specific antigen testing.
Published Date: 02/28/2023
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for testosterone testing.
Published Date: 02/28/2023
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
This Medicare Advantage and commercial policy outlines Humana’s reimbursement guidelines for laboratory charges for vitamin B12 testing.
Published Date: 02/28/2023
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on outpatient claim itemized bill reviews.
Published Date: 02/08/2023
This Medicare Advantage, commercial and Medicaid policy establishes Humana's expectations regarding cost-sharing for cost-share protected members.
Published Date: 12/02/2022
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
This Kentucky Medicaid policy establishes guidelines for how Humana determines the appropriate NICU DRG code for reimbursement.
Published Date: 04/29/2022
This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for Opioid Treatment Programs (OTPs).
Published Date: 08/27/2021
This Medicare Advantage and commercial policy establishes Humana's billing requirements and reimbursement for anesthesia services.
Published Date: 08/20/2021
This commercial and Medicaid policy outlines Humana’s billing requirements and reimbursement for state-supplied vaccines.
Published Date: 05/14/2021
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
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
This Medicare Advantage and commercial policy establishes Humana's billing and reimbursement guidelines for RAP and NOA submissions.
Published Date: 01/21/2021
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
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
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
This policy outlines Humana’s expectation for reporting codes and other data on claims billed to Humana plans.
Published Date: 11/05/2020
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s billing expectations for COVID-19 related claims.
Published Date: 07/30/2020
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
This Medicare Advantage, commercial and Medicaid policy outlines Humana’s inpatient readmission review standards.
Published Date: 01/16/2020
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
This Medicare Advantage and commercial policy establishes Humana’s policy on billing members for missed appointments.
Published Date: 08/02/2019
This Medicare Advantage and Medicaid policy establishes Humana’s policy on electronic transactions.
Published Date: 06/19/2019
This commercial policy establishes how Humana plans reimburse charges for obstetric billing, including antepartum, delivery and postpartum care.
Published Date: 06/19/2019
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s requirments for billing and documentation of observation services.
Published Date: 04/02/2019
This commercial policy establishes how Humana plans reimburse charges for robotic and computer assisted surgeries.
Published Date: 01/08/2019
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
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
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
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
This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse a charge reported with modifier FX.
Published Date: 08/29/2017
This Medicare Advantage, commercial and Medicaid policy establishes how Humana plans reimburse a charge reported with modifier FY.
Published Date: 08/29/2017
This Medicare Advantage and commercial policy establishes how Humana plans apply multiple procedure payment reductions.
Published Date: 03/29/2017
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s ordering and referring requirements for health care providers.
Published Date: 03/29/2017
This commercial policy establishes how Humana plans reimburse charges for rehabilitative and habilitative services.
Published Date: 12/29/2016
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
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
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
This commercial policy establishes how Humana plans reimburse charges for provider-based clinic services.
Published Date: 09/22/2016
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
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on proof of delivery for DMEPOS items.
Published Date: 07/18/2016
This Medicare Advantage, commercial and Medicaid policy establishes Humana’s policy on itemized bill review for inpatient routine services.
Published Date: 06/24/2016
This Medicare Advantage and commercial policy establishes how Humana plans reimburse inpatient to outpatient rebilling.
Published Date: 06/16/2016
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for transitional care management.
Published Date: 05/11/2016
This Medicare Advantage and commercial policy establishes how Humana plans reimburse pass-through billing charges.
Published Date: 02/25/2016
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
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
This Medicare Advantage policy establishes how Humana plans reimburse charges for initial preventive physical examinations and annual wellness visits.
Published Date: 03/24/2015
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
This Medicare Advantage and Medicaid policy establishes Humana’s NDC billing requirement.
Published Date: 02/25/2015
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
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
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for drug testing.
Published Date: 12/24/2014
This Medicare Advantage and commercial policy outlines Humana’s billing requirements and reimbursement for CPT code 77427.
Published Date: 12/24/2014
This Medicare Advantage and commercial policy establishes Humana’s assistant at surgery reimbursement policy.
Published Date: 12/12/2014
This commercial policy establishes guidelines how Humana plans determine the appropriate NICU level of care for reimbursement.
Published Date: 12/01/2014
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
This Medicare Advantage and commercial policy establishes how Humana plans reimburse a charge reported with modifier EY.
Published Date: 09/19/2014
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for a screening colonoscopy.
Published Date: 09/19/2014
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for after-hours CPT® codes 99050 – 99060.
Published Date: 07/01/2014
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for increased procedural services.
Published Date: 07/01/2014
This Medicare Advantage and commercial policy outlines Humana’s expectation that an itemized bill be made available upon request.
Published Date: 07/01/2014
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for DME capped rental items.
Published Date: 06/20/2014
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
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
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges a transcutaneous electrical nerve stimulator (TENS) device.
Published Date: 06/20/2014
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
This Medicare Advantage and commercial policy establishes how Humana plans reimburse charges for co-sugeons.
Published Date: 06/20/2014
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.