Humana prior authorization, page 16

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
81260	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81265	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81266	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81269	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81272	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81273	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81275	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81276	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81277	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81278	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81279	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81283	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81284	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81286	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81287	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81290	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81291	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81292	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81294	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
81295	Molecular diagnostic and genetic testing	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 23 Original policy
97605	Negative pressure wound therapy (NPWT)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
97606	Negative pressure wound therapy (NPWT)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
A6550	Negative pressure wound therapy (NPWT)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
E2402	Negative pressure wound therapy (NPWT)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
K0743	Negative pressure wound therapy (NPWT)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
A4593	Neuromuscular stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
A4594	Neuromuscular stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
E0764	Neuromuscular stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
E0770	Neuromuscular stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61860	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61863	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61867	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61885	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61886	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61889	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61891	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
61892	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64553	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64555	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64561	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64566	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64567	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64568	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64575	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64581	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64590	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64596	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64597	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
64598	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
0587T	Neurostimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 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.