Humana Updated Claim Payment Policies

November 2018 ~

Humana recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.

The following policy outlines from Humana details how the plans make reimbursements for telehealth services possible. Note: In addition to the policy, claims payments are subject to other plan requirements for the processing and payment of claims, including, but not limited to, requirements of medical necessity and reasonableness and applicable referral or authorization requirements.

Medicare Advantage Payment Policy

For services provided January 1, 2017, or after, Original Medicare (OM) requires the use of place of service (POS) code 02 on professional claims for telehealth, telemedicine and interprofessional telephone or internet assessment and management services. For services provided before January 1, 2018, OM required telehealth, telemedicine and interprofessional telephone or internet assessment and management services to be identified with modifier GT.

Humana Medicare Advantage (MA) plans cover and identify telehealth, telemedicine, and interprofessional telephone or internet assessment and management services consistent with OM.

A Humana MA plan may have a supplemental benefit that covers specific telehealth, telemedicine and interprofessional telephone or internet assessment and management services. For additional details, providers and members are advised to contact Humana to verify whether a Humana MA plan has the supplemental benefit.

Commercial Payment Policy

Humana commercial plans identify telehealth, telemedicine and interprofessional telephone or internet assessment and management services by requiring the use of modifier GT, modifier 95 or POS code 02.

Humana commercial plans cover telehealth, telemedicine and interprofessional telephone or internet assessment and management services with the following exception:

• Internet-only telemedicine services, Current Procedural Terminology (CPT^®) codes 99444 and 98969, are not covered unless provided pursuant to a Humana telemedicine vendor partnership or when required by an applicable state mandate.

Medicaid Payment Policy

Humana Medicaid plans cover telehealth, telemedicine and interprofessional telephone or internet assessment and management services consistent with federal law and state Medicaid agency requirements.

CPT^® is a registered trademark of the American Medical Association.

Source(s): Humana’s YourPractice Newsletter October 2018;