Humana prior authorization, page 13

Requirements

Notification and authorization stay separate. An approved notification row keeps the notification label. The long descriptor is blank because no AMA-licensed CPT file was available to copy.

CPT code lookup

Prior authorization codes

Prior authorization codes
Code	Description	Source
43253	Esophagogastroduodenoscopy (EGD)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 16 Original policy
43259	Esophagogastroduodenoscopy (EGD)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 16 Original policy
64490	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64491	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64492	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64493	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64494	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64495	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64633	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64634	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64635	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64636	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
64999	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
0213T	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
0214T	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
0215T	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
0216T	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
0217T	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
0218T	Facet injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
95807	Facility-based sleep studies (PSG)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
95808	Facility-based sleep studies (PSG)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
95810	Facility-based sleep studies (PSG)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
95811	Facility-based sleep studies (PSG)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
26535	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
26536	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28110	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28240	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28285	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28289	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28291	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28292	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28295	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28296	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28297	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28298	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28299	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28306	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28308	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28310	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28740	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
28750	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
L8641	Foot surgeries, bunionectomy and hammertoe	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 17 Original policy
43647	Gastric pacing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
43648	Gastric pacing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
43881	Gastric pacing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
43882	Gastric pacing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
64454	Genicular Nerve Ablation and	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
64624	Genicular Nerve Ablation and	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
E0483	High-frequency chest compression vests	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy
99512	Home health/home infusion	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 18 Original policy

Medicare

The rows above are limited to the Medicare Advantage scopes in each table. They are not a single Medicare answer. Each row shows its own reviewed disposition.

Precertification list

Humana Medicare Advantage and D-SNP prior authorization and notification list

Humana prior authorization lists

Humana prior authorization search tool

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.