Humana Policy and Claims Payment System Updates
October 2018 ~
Humana has posted a number of policy and claims payment system updates that will become effective in next month.
The following policies will become effective as of November 1, 2018.
Correct Coding
Topic: Care management services for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
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Topic: Oyxgen rate modifiers
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Topic: Mohs micrographic technique
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Topic: Allergen Immunotherapy
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Topic: Nonspecific Healthcare Common Procedure Coding System (HCPCS) Level II code billed with an inappropriate National Drug Code (NDC)
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Topic: Obstetric ultrasound
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Topic: HCPCS code G0499, hepatitis B screening in nonpregnant high-risk individuals
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Topic: High-intensity behavioral counseling (HIBC) to prevent sexually transmitted infections
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Topic: High-intensity behavioral counseling
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Topic: Eligible bill types for high-intensity behavioral counseling (HIBC) for sexually transmitted infections
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CPT
Topic: Penile venous occlusive procedure
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Topic: Molecular diagnostic testing for reproductive health
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CPT – Evaluation and Management Services
Topic: Care management services
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CPT – Lab / Pathology
Topic: Hepatitis B screening
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Topic: Glycated hemoglobin, glycated protein, and lipid testing
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Topic: Screening for hepatitis B virus (HBV) for pregnant women
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Topic: HCPCS code G0499, hepatitis B screening in nonpregnant, high-risk individual
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Topic: Screening for hepatitis C virus (HCV) in adults
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CPT – Medicine
Topic: Influenza vaccine
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CPT – Radiology
Topic: Ultrasound (nonobstetric)
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Diagnoses
Topic: Endoscopic colorectal cancer screening for patients younger than 50
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Topic: Special ophthalmological services
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Topic: Cervical cancer screening
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Topic: Urinary catheter for incontinence
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HCPCS
Topic: Replacement batteries for electrical stimulators
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Topic: Breast pump supplies
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HCPCS – DMEPOS
Topic: Oxygen equipment items billed with modifier QG – prescribed amount of oxygen is greater than 4 liters per minute
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HCPCS – Drugs & Biologicals
Topic: Bendamustine HCl, 1mg
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Topic: Brentuximab vedotin for patients with Hodgkin’s lymphoma (classical)
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Topic: Alimta (pemetrexed)
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Topic: Octreotide, depot form for intramuscular injection, 1 mg
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Topic: Golimumab when billed with a diagnosis of rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis.
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Topic: Omalizumab
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Topic: Yervoy (ipilimumab)
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Topic: Vedolizumab
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Topic: Rituximab
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Units
Topic: Florida Medicaid durable medical equipment (DME) limits
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CPT® is a registered trademark of the American Medical Association.
Source(s): Humana’s YourPractice Newsletter August 2018;