A physician laughs with a patient while reviewing their chart

Clinical coverage policies are resources for physicians and other Humana-contracted healthcare professionals providing care to our members enrolled in Humana Healthy Horizons® in Ohio. Humana Healthy Horizons in Ohio has adopted the following behavioral and physical health clinical coverage policies.

When filing electronic Medicaid claims, please use Payer ID 61103 for your patients with coverage through Humana Healthy Horizons in Ohio. Please do not use Humana’s traditional Payer ID for fee-for-service claims (61101) when submitting Humana Healthy Horizons in Ohio Medicaid claims. Learn more about filing electronic claims .

Physical and Behavioral Health Clinical Coverage Policies

Active

OH.CLI.1383 Medical Necessity Guidelines

OH.CLI.1348 Miscellaneous, Other and Not Otherwise Specified Codes

Upcoming

Behavioral Health Clinical Coverage Policies

Active

Coming soon

Upcoming

Physical Health Clinical Coverage Policies

Active

OH.CLI.1373 Prosthetics

OH.CLI.H1376 Inhaled Nitric Oxide

OH.CLI.1378 Breast Reconstruction

OH.CLI.1379 Gene Expression Profiling for Cancer Indications

OH.CLI.1381 Noninvasive Prenatal Testing

Upcoming

Medicaid Breast Reconstruction HUM-2030-000 OH  

Medicaid Pharmacogenomics Testing HUM-2240-000 OH

Pharmacy Clinical Coverage Policies

HU-P1001-Abraxane (nab-paclitaxel) 03-13-2024

HU-P1002-Aduhelm (aducanumab) 03-13-2024

HU-P1003-Aloxi (palonosetron) 03-13-2024

HU-P1004-Alpha‐1 Proteinase Inhibitors (Aralast NP, Glassia) 03-13-2024

HU-P1005-Alpha‐1 Proteinase Inhibitors (Prolastin‐C, Zemaira) 03-13-2024

HU-P1006-Amvuttra (vutrisiran) 03-13-2024

HU-P1008-Beovu (brolucizumab) 03-13-2024

HU-P1009-Bevacizumab products 03-13-2024

HU-P1010-Bortezomib products (Velcade and Bortezomib for injection) Coversheet 03-13-2024

HU-P1011-Byooviz (ranibizumab‐nuna) 03-14-2024

HU-P1012-Carvykti (ciltacabtagene autoleucel) 03-14-2024

HU-P1013-Corticotropin Products 03-14-2024

HU-P1015-Enjaymo (sutimlimab‐jome) 03-14-2024

HU-P1016-Entyvio (vedolizumab) 03-14-2024

HU-P1019-Fyarro (sirolimus protein‐bound particles) 03-14-2024

HU-P1021-Inflectra (infliximab‐dyyb) 03-18-2024

HU-P1022-IVIG Immune Globulin 03-14-2024

HU-P1024-Kimmtrak (tebentafusp‐tebn) 03-14-2024

HU-P1025-Korsuva (difelikefalin) 03-14-2024

HU-P1026-Leqvio (inclisiran) 03-14-2024

HU-P1027-Levoleucovorin products (Fusilev, Khapzory) 03-14-2024

HU-P1028-Liposomal doxorubicin 03-14-2024

HU-P1029-Lucentis (ranibizumab) 03-13-2024

HU-P1031-Nexviazyme (avalglucosidase‐alfa) 03-18-2024

HU-P1033-Opdualag (nivolumab and relatlimab‐rmbw) 03-18-2024

HU-1034-Parsabiv (etelcalcetide) 03-18-2024

HU-P1035-Pemetrexed Products 03-18-24

HU-P1036-Pluvicto (lutetium Lu 177 vipivotide tetraxetan) 03-18-2024

HU-P1039-Rituxan Hycela (rituximab-hyaluronidase) 03-18-2024

HU-P1040-Rituximab products 03-18-2024

HU-P1041-Rybrevant (amivantamab) 03-13-2024

HU-P1042-Rylaze (asparaginase Erwinia chrysanthemi recombinant‐rywn) 03-18-2024

HU-P1043-Ryplazim (plasminogen, human‐tvmh) 03-18-2024

HU-P1044-Saphnelo (anifrolumab-fnia) 03-18-2024

HU-P1046-Somatuline Depot (lanreotide) 03-13-2024

HU-P1047-Sustol (granisetron) 03-18-2024

HU-P1048-Susvimo (ranibizumab) 03-18-2024

HU-P1050-Tivdak (tisotumab vedotin-tftv) 03-18-2024

HU-P1051-Vabysmo (faricimab‐svoa) 03-18-2024

HU-P1052-Viscosupplements Coversheet 03-18-2024

HU-P1054-Vyvgart (efgartigimod alfa‐fcab) 03-18-2024

HU-P1055-Xipere (triamcinolone acetonide) 03-18-2024

HU-P1057- Non Preferred Infliximab Products 03-18-2024

Panhematin® (heme for injection) intravenous solution

Pedmark® (sodium thiosulfate injection)

Ohio Medicaid

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