Humana prior authorization, page 18

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
43771	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43772	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43773	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43774	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43775	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43842	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43843	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43845	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43846	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43847	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43848	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43886	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43887	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43888	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
43889	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
C9785	Obesity surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 26 Original policy
20910	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21010	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21050	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21070	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21085	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21100	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21110	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21125	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21127	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21141	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21142	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21143	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21145	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21146	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21147	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21150	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21151	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21154	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21155	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21159	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21160	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21188	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21193	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21194	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21195	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21196	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21198	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21199	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21206	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21208	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21210	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21215	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21240	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21242	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 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.