Humana Claim Processing Edit Updates

July 2019 ~

Humana has published new claim processing edit updates, including changes to CPT codes 81320 – PLCG2, CPT codes 81233 – BTK, and more.

Procedure/Policy: EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit)

Effective Date: 7/4/2019

Update: Humana does not reimburse charges for CPT codes 81236 or 81237, EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit).

Humana’s policy on genetic testing for the diagnosis and monitoring of cancer indications and molecular profiling has been updated to indicate that the service above is not covered for any indication.

Procedure/Policy: MYD88 (myeloid differentiation primary response 88) (e.g., Waldenstrom’s macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant

Effective Date: 7/4/2019

Update: Humana does not reimburse charges for CPT code 81305, MYD88 (myeloid differentiation primary response 88, e.g., Waldenstrom’s macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant.

Humana’s policy on genetic testing for the diagnosis and monitoring of cancer indications and molecular profiling has been updated to indicate that the service above is not covered for any indication.

Procedure/Policy: HCPCS code E1820, replacement soft interface material, dynamic adjustable extension/flexion device

Effective Date: 7/4/2019

Update: Humana does not reimburse charges for HCPCS code E1820.

Humana’s policy on continuous passive motion (CPM) and mechanical stretching devices has been updated to indicate that HCPCS code E1820 is not covered for any indication.

Procedure/Policy: HCPCS code E1825, dynamic adjustable finger extension/flexion device, includes soft interface material

Effective Date: 7/4/2019

Update: Humana does not reimburse charges for HCPCS code E1825.

Humana’s policy on continuous passive motion (CPM) and mechanical stretching devices has been updated to indicate that the service above is not covered for any indication.

Procedure/Policy: CPT code 81233 – BTK (Bruton’s tyrosine kinase) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., C481S, C481R, C481F)

Effective Date: 8/1/2019

Update: Humana does not reimburse CPT code 81233.

Humana’s policy on pharmacogenomics and companion diagnostics has been updated to indicate that CPT code 81233 is not covered for any indication.

Procedure/Policy: CPT code 81320 – PLCG2 (phospholipase C gamma 2) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., R665W, S707F, L845F)

Effective Date: 8/1/2019

Update: Humana does not reimburse CPT code 81320.

Humana’s policy on pharmacogenomics and companion diagnostics has been updated to indicate that CPT code 81320 is not covered for any indication.

For more information, refer to Humana’s Medical and Pharmacy Coverage Policies page and enter the code number in the keyword search bar.

View all recent and past updates, see Humana’s Claim Processing Edits page.

Source(s): Humana Claim Processing Edits Results;

 

 

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