Humana prior authorization, page 19

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
21243	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21244	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
21247	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
29800	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
29804	Oral, orthognathic, temporomandibular joint (TMJ) surgeries	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
23472	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
23473	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
23474	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27125	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27130	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27132	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27134	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27137	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27138	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27437	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27438	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27440	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27441	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27442	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27443	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27446	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27447	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27486	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
27487	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
C8003	Orthopedic surgeries: hip, knee and shoulder arthroplasty	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 27 Original policy
23929	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
27299	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
27412	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
27599	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29805	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29806	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29807	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29819	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29820	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29821	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29822	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29823	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29824	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29825	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29826	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29827	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29828	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29850	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29851	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29860	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29861	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29862	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29863	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29866	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 Original policy
29867	Orthopedic surgeries: hip, knee and shoulder arthroscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 28 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.