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Prior authorization submission information

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Prior authorization for professionally administered drugs 

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Fee schedules

From time to time, the Kentucky Department for Medicaid Services (Kentucky DMS) updates fee schedules for existing published codes and modifiers allowable for Kentucky Medicaid enrollees. Humana Healthy Horizons® in Kentucky does not adjust previously paid claims in accordance with retroactive fee schedule modifications issued by Kentucky DMS.

We publish the date we update our claims adjudication system to the new rate. You’ll find the current configuration below in the Published fee schedule notices section.

In the circumstance a modification to the Kentucky DMS fee schedule is the addition of a new code or modifier, Humana adjusts previously adjudicated claims impacted by such a modification in accordance with all applicable retroactive effective date.

Reimbursement of published fee schedules are subject to provisions within in-network provider contract agreements and the Out of Network Claims Payment Policy.

The following provider types are included in this policy:

Advanced registered nurse practitioner (ARNP) - 78, 789

Ambulatory surgical centers - 36

Audiologist - 70, 709

Behavioral health multi-specialty group - 66

Behavioral health services organization - 03

Birthing centers - 73

Certified registered nurse anesthetist (CRNA) - 74, 749

Chiropractor - 85, 859

Community mental health centers - 30

Comprehensive outpatient rehabilitation facilities - 91

Dentist - 60, 61

Early Periodic Screening Diagnosis and Treatment Services - screenings - 45

Early Periodic Screening Diagnosis and Treatment Services - special services - 45

Emergency transportation - 55

Family planning services - 32

Federally Qualified Health Center (FQHC)/non-FQHC - 31

Hearing aid dealer - 50, 509

Home health services - 34

Hospice services - 44

Hospitals - 01

Independent laboratory and radiological services - 37

Licensed behavioral analyst - 63, 639

Licensed clinical alcohol and drug counselor - 67, 679

Licensed clinical social worker - 82, 829

Licensed marriage and family therapist - 83, 839

Licensed professional art therapist - 62, 629

Licensed professional clinical counselor - 81, 819

Licensed psychological practitioner - 84, 849

Licensed psychologist - 89, 899

Multi therapy agency - 76

Non-emergency transportation - 56

Nursing facility - 12

Occupational therapist - 88, 889

Optician - 52, 529

Optometrist - 77, 779

Physical therapist - 87, 879

Physician assistant - 95, 859

Physician services - 64, 65

Podiatry services - 80, 809

Primary care - 31

Private duty nursing (PDN) - 18

Psychiatric distinct part unit (DPU) - 92

Psychiatric hospital - 02

Psychiatric residential treatment facility I - 04

Psychiatric residential treatment facility II - 05

Radiological services and other lab and X-ray - 86

Rehabilitative distinct part unit (DPU) - 93

Renal dialysis service - 39

Residential crisis stabilization unit - 26

Rural health services - 35

Specialized children's services clinic or child advocacy centers - 13

Speech-language pathologist - 79, 799

Targeted case management and rehab services provided through title V services – 23

Thank you for the high-quality care you provide your patients with coverage through Humana Healthy Horizons in Kentucky.

Published fee schedule notices

Ambulatory surgical center (ASC) services

KDMS ASC fee schedule system configuration effective 8/13/2023
KDMS ASC fee schedule system configuration effective 04/19/2025

Audiology
KDMS audiology fee schedule system configuration effective 8/13/2023
KDMS audiology fee schedule system configuration effective 8/24/2023
KDMS audiology fee schedule system configuration effective 11/14/2023
KDMS audiology fee schedule system configuration effective 2/16/2024
KDMS audiology fee schedule system configuration effective 7/1/2025

Behavioral health
KDMS behavioral health fee schedule system configuration effective 8/13/2023
KDMS behavioral health fee schedule system configuration effective 4/1/2024 
KDMS behavioral health fee schedule system configuration effective 7/18/2025

Chiropractor
KDMS chiropractor fee schedule system configuration effective 8/13/2023
KDMS chiropractor fee schedule system configuration effective 2/08/2024
KDMS chiropractor fee schedule system configuration effective 6/11/2025

Clinical laboratory
KDMS clinical laboratory fee schedule system configuration effective 8/13/2023
KDMS clinical laboratory fee schedule system configuration effective 8/14/2023
KDMS clinical laboratory fee schedule system configuration effective 3/5/2024
KDMS clinical laboratory fee schedule system configuration effective 6/8/2024
KDMS clinical laboratory fee schedule system configuration effective 11/20/2024
KDMS clinical laboratory fee schedule system configuration effective 07/15/2025

COVID-19 antibody infusion therapy
KDMS COVID-19 antibody infusion therapy fee schedule system configuration effective 8/13/2023

Dental
KDMS dental fee schedule system configuration effective 8/13/2023
KDMS dental fee schedule system configuration effective 8/24/2023
KDMS dental fee schedule system configuration effective 11/29/23
KDMS dental fee schedule system configuration effective 2/07/24
KDMS dental fee schedule system configuration effective 2/28/24
KDMS dental fee schedule system configuration effective 6/08/2024
KDMS dental fee schedule system configuration effective 7/8/2025

Home health
 KDMS home health fee schedule system configuration effective 8/13/2023

Hospice
KDMS hospice fee schedule system configuration effective 8/13/2023
KDMS hospice fee schedule system configuration effective 11/8/2023

Medical supplies, equipment, and appliances (MSEA) – formerly Durable medical equipment (DME)
KDMS DME fee schedule system configuration effective 8/13/2023
KDMS DME fee schedule system configuration effective 8/24/2023
KDMS DME fee schedule system configuration effective 10/4/2023
KDMS DME fee schedule system configuration effective 11/29/2023
KDMS DME fee schedule system configuration effective 12/02/2023
KDMS DME fee schedule system configuration effective 1/3/2024
KDMS DME fee schedule system configuration effective 2/6/2024
KDMS DME fee schedule system configuration effective 2/23/2024
KDMS DME fee schedule system configuration effective 6/6/2024 
KDMS MSEA fee schedule system configuration effective 10/23/2024
KDMS MSEA fee schedule system configuration effective 7/2/2025

National Drug Code (NDC) to Procedure Code Crosswalk (formerly the Physician administered drug (PAD) list)
 KDMS PAD fee schedule system configuration effective 8/13/2023
KDMS PAD fee schedule system configuration effective 8/17/2024
NDC - Procedure Code Crosswalk effective 5/10/2025
NDC - Procedure Code Crosswalk effective 7/8/2025

Nursing facility laboratory
KDMS nursing facility laboratory fee schedule system configuration effective 8/13/2023

Occupational therapy
KDMS occupational therapy fee schedule system configuration effective 8/13/2023
KDMS occupational therapy fee schedule system configuration effective 2/01/2024
KDMS occupational therapy fee schedule system configuration effective 2/09/2024
KDMS occupational therapy fee schedule system configuration effective 4/06/2025

Physical therapy
KDMS physical therapy fee schedule system configuration effective 8/13/2023
KDMS physical therapy fee schedule system configuration effective 2/01/2024
KDMS physical therapy fee schedule system configuration effective 2/09/2024
KDMS physical therapy fee schedule system configuration effective 4/06/2025

Physician
KDMS physician fee schedule system configuration effective 8/13/2023
KDMS physician fee schedule system configuration effective 8/14/2023
KDMS physician fee schedule system configuration effective 8/24/2023
KDMS physician fee schedule system configuration effective 10/6/2023
KDMS physician fee schedule system configuration effective 2/06/2024
KDMS physician fee schedule system configuration effective 4/03/2024
KDMS physician fee schedule system configuration effective 5/14/2024
KDMS physician fee schedule system configuration effective 5/29/2024
KDMS physician fee schedule system configuration effective 5/30/2025
KDMS Physician Fee Schedule System Configuration Effective 7/15/2025

Private duty nursing supplies
 KDMS revised 9/14/2023 private duty nursing supplies fee schedule system configuration effective 8/13/2023
KDMS private duty nursing supplies fee schedule system configuration effective 8/13/2023

Preventive health
KDMS preventive health fee schedule system configuration effective 8/13/2023
KDMS Preventive Health fee schedule system configuration effective 10/6/2023
KDMS Preventive Health fee schedule system configuration effective 1/8/2024
KDMS Preventive Health fee schedule system configuration effective 1/18/2024
KDMS Preventive Health fee schedule system configuration effective 1/22/2024
KDMS Preventive Health fee schedule system configuration effective 2/1/2024
KDMS Preventive Health fee schedule system configuration effective 2/12/2024
KDMS Preventive Health fee schedule system configuration effective 3/06/2024
KDMS Preventive Health fee schedule system configuration effective 7/19/2024
KDMS Preventive Health fee schedule system configuration effective 10/22/2024 
KDMS Preventive Health Fee Schedule System Configuration Effective 9/18/2025

Radiology
KDMS radiology fee schedule system configuration effective 8/13/2023

Renal dialysis – Medicare Part B drugs
KDMS renal dialysis – Medicare Part B drugs fee schedule system configuration effective 8/13/2023
KDMS renal dialysis – Medicare Part B drugs fee schedule system configuration effective 6/19/24
KDMS renal dialysis – Medicare Part B drugs fee schedule system configuration effective 8/11/2025

Speech therapy
KDMS speech therapy fee schedule system configuration effective 8/13/2023
KDMS speech therapy fee schedule system configuration effective 12/20/2023
KDMS speech therapy fee schedule system configuration effective 2/01/2024
KDMS speech therapy fee schedule system configuration effective 2/09/2024
KDMS speech therapy fee schedule system configuration effective 8/17/2024
KDMS speech therapy fee schedule system configuration effective 4/06/2025

Transportation
KDMS transportation fee schedule system configuration effective 8/13/2023
KDMS transportation fee schedule system configuration effective 1/12/2024
KDMS transportation fee schedule system configuration effective 6/18/2025

Vision
KDMS vision fee schedule system configuration effective 8/13/2023
KDMS vision fee schedule system configuration effective 11/20/2023
KDMS vision fee schedule system configuration effective 12/19/2023
KDMS vision fee schedule system configuration effective 1/3/2024
KDMS vision fee schedule system configuration effective 2/2/2024
KDMS vision fee schedule system configuration effective 3/16/2024
KDMS vision fee schedule system configuration effective 7/3/2025

Vision contact lens
 KDMS vision contact lens fee schedule system configuration effective 3/15/2024
KDMS vision contact lens fee schedule system configuration effective 7/1/2025