Humana prior authorization, page 4

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
0413T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0414T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0415T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0416T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0417T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0418T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0571T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0572T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0573T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0574T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0580T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0614T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0795T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0796T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0797T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0798T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0799T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0800T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0801T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0802T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0803T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0823T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0824T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0825T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0826T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0915T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0916T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0917T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0918T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0919T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0920T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0921T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0922T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0923T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0924T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0925T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0926T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0927T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0933T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0934T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0981T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0982T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
0983T	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
1050T*	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
1051T*	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
C1605	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
C1721	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
C1722	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
C1777	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 Original policy
C1779	Cardiac implantable devices (e.g., CardioMEMS pacemakers, leadless pacemakers, left atrial appendage closure [LAAC], defibrillators [implantable and subcutaneous] and cardiac resynchronization therapy)	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List, Pg 9 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

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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.

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