Humana prior authorization, page 15

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
81175	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81176	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81177	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81178	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81179	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81180	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81181	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81182	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81183	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81184	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81185	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81187	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81189	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81191	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81192	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81193	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81194	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81195	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81200	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81201	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81203	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81204	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81205	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81212	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81216	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81218	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81219	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81220	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81223	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81225	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81226	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81227	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81229	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81230	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81231	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81233	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81234	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81236	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81240	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81241	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81242	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81243	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81244	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81247	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81249	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81250	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81251	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81255	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81257	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81259	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 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.