Humana prior authorization, page 2

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
67923	Select UM Prior Authorization under UM Actions, and	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 6 Original policy
67924	New Request. should contact their Provider Relations com. Requests may also be	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 6 Original policy
67950	New Request. should contact their Provider Relations com. Requests may also be	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 6 Original policy
E0747	Bone growth stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
E0748	Bone growth stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
E0760	Bone growth stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
19120	Breast cancer biopsy (excisional)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
19125	Breast cancer biopsy (excisional)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
19301	Breast lumpectomy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
19302	Breast lumpectomy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 7 Original policy
11971	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19316	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19318	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19325	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19328	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19330	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19340	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19342	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19350	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19357	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19370	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19371	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19380	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
0970T	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
0971T	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
C1789	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
L8600	Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19300	Simple mastectomy and gynecomastia surgery (excludes radical and modified)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
19303	Simple mastectomy and gynecomastia surgery (excludes radical and modified)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
91110	Simple mastectomy and gynecomastia surgery (excludes radical and modified)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
91111	Simple mastectomy and gynecomastia surgery (excludes radical and modified)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
91113	Simple mastectomy and gynecomastia surgery (excludes radical and modified)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
0651T	Capsule endoscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
0977T	Capsule endoscopy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33875	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33877	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33880	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33881	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33882	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33883	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
33886	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34701	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34702	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34703	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34704	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34705	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34706	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34830	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34831	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 Original policy
34832	Aortic repair	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 8 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.