Humana Updates Preauthorization and Notification Lists for 2018

January 2018 ~

On January 22nd, Humana will update its preauthorization and notification lists for all commercial fully insured, Medicare Advantage plans and dual Medicare-Medicaid plans.

Humana will require reauthorization for the following procedures:

  • Left Atrial Appendage Closure (LAAC) device (e.g.; Watchman), lung biopsy and resection and simple mastectomy and gynecomastia surgery (excluding radical and modified) for comercial fully insured, MA and dual Medicare-Medicaid plans. Preauthorization requests will be reviewed by HealthHelp.
  • Epidural Injections will continue to be managed by OrthoNet for commercial fully insured, MA and dual Medicare-Medicaid plans.
  • Medications delivered in the physician’s office, clinic, outpatient or home setting is expanding to include all medications noted with an asterisk (*) on the preauthorization lists on the preauthorization lists posted on
  • Preferred viscosupplementals will be Monovisc and Orthovisc and will no longer require preauthorization. All other viscosupplementals will require preauthorization for commercial fully insured, MA and dual Medicare-Medicaid plans.
  • National Drug Code (NDC) Billing Requirement: For some Healthcare Common Procedure Coding System (HCPCS) drug codes, Humana requires all health care providers to submit each charge with the valid, corresponding NDC. For all other HCPCS drug codes, Humana asks prescribers to submit charges with valid, corresponding NDCs.



Source(s): YourPractice;