Humana prior authorization, page 25

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
77424	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77425	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77436	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77437	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77438	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77439	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77520	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77522	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77523	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77525	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77750	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77761	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77762	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77763	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77767	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77768	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77770	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77771	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
77772	Radiation therapy	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 35 Original policy
64625	Radiofrequency Ablation for the SI	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30400	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30410	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30420	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30430	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30435	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30450	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30460	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30462	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30468	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
30469	Rhinoplasty and other nasal procedures	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
27096	Sacroiliac (SI) joint injections	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2001	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2002	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2004	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2005	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2006	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2007	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2008	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2009	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2010	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2011	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2012	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2013	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2014	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2015	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
A2016	Skin and tissue substitutes	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 36 Original policy
0784T	Spinal cord stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 40 Original policy
0785T	Spinal cord stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 40 Original policy
63650	Spinal cord stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 40 Original policy
63655	Spinal cord stimulators	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 40 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.