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;

 

 

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