Humana Claims Payment and Medical Coverage Policy Updates

February 2020 ~

Humana has published new and recently updated claim payment policies, including new policies for inpatient readmission review, modifiers CO and CQ, as well as revisions to the insurer’s chronic care management and principal care management and telehealth services policies.

Humana has made changes to the following policies:

New Claims Payment Policies

  • Inpatient Readmission Review
  • Modifiers CO and CQ

Updated Claims Payment Policies

  • Chronic Care Management and Principal Care Management
  • Telehealth Services

New Medical Coverage Policies

  • Code Compendium (Laboratory)
  • Prostatectomy

Medical Coverage Policies with Significant Revisions

  • Biofeedback
  • Bone Density Measurement
  • Capsule Endoscopy
  • Carpal Tunnel Syndrome (CTS) Surgical Treatments
  • Cold Therapy Devices/Heating Devices/Combined Heat and Cold Therapy Devices
  • Comparative Genomic Hybridization/Chromosomal Microarray Analysis
  • Cosmetic Surgery, Reconstructive Surgery, Scar Revision
  • Diagnostic Esophagogastroduodenoscopy (EGD) or Esophagoscopy (age 59 or younger)
  • Drug Testing
  • Electrical Stimulators for Pain and Nausea-Vomiting
  • Extended Ophthalmoscopy
  • Fecal Incontinence Treatments
  • Genetic Testing for Angelman Syndrome and Prader Willi Syndrome
  • Genetic Testing for Carrier Screening
  • Genetic Testing for Colorectal Cancer Susceptibility
  • Left Atrial Appendage and Cardiac Structural Defect Closure for Stroke Prevention
  • Multianalyte Assays with Algorithmic Analyses (MAAAs)
  • Noninvasive Prenatal Screening
  • Obstructive Sleep Apnea (OSA) and Other Sleep Related Breathing Disorders Nonsurgical


  • Pharmacogenomics and Companion Diagnostics
  • Serological and Fecal Testing for Inflammatory Bowel Disease (IBD)
  • Skin and Tissue Substitutes Spinal Decompression Surgery
  • Spinal Fusion Surgery
  • Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
  • Ultraviolet Light/Laser Therapy for Skin Conditions
  • Urinary Incontinence Evaluation and Treatments

Humana publishes its medical claims payment policies online. For more information on Humana’s updated policies, see Humana claims payment policies page.

Source(s): Humana’s Your Practice, January 2020;