Humana prior authorization, page 22

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
L3674	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3720	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3730	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3740	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3763	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3764	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3765	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3766	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3900	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3901	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3904	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3905	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3961	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3971	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3973	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3977	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L3999	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L4631	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L8701	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
L8702	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62324	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62325	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62326	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62327	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62350	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62351	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62360	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62361	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
62362	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
64999	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
C1772	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
C1891	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
C2626	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
C9804	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
C9806	Orthotics	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 29 Original policy
E0782	(online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
E0783	(online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
E0785	(online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
E0786	(online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
54405	Penile implant disc injection	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
0627T	Penile implant disc injection	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
0628T	Penile implant disc injection	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
0629T	Penile implant disc injection	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
0630T	Penile implant disc injection	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 30 Original policy
0234T	nboarding information: m/provider/resources (online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 31 Original policy
0235T	nboarding information: m/provider/resources (online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 31 Original policy
0236T	nboarding information: m/provider/resources (online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 31 Original policy
0237T	nboarding information: m/provider/resources (online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 31 Original policy
0238T	nboarding information: m/provider/resources (online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 31 Original policy
37236	nboarding information: m/provider/resources (online): request a new account: nboarding information: m/provider/resources	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 31 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.