Non-coronary revascularization

37238

excludes dialysis access maintenance

Colonoscopy

45378

Repeat only, not initial

Genicular Nerve Ablation and Genicular Nerve Blocks

64454

Neurostimulators

64555

Neurostimulators

64575

Genicular Nerve Ablation and Genicular Nerve Blocks

64624

Radiofrequency Ablation for the SI Joint

64625

Molecular diagnostic/genetic testing

84433

Cardiac Procedures/Surgeries

92924

Outpatient coronary angioplasty/stent

Cardiac Procedures/Surgeries

92933

Outpatient coronary angioplasty/stent

Cardiac Procedures/Surgeries

93580

Patent foramen ovale (PFO) and atrial septal defect (ASD) closure

Molecular diagnostic/genetic testing

0004M

Molecular diagnostic/genetic testing

0005U

Molecular diagnostic/genetic testing

0007M

Molecular diagnostic/genetic testing

0009U

Molecular diagnostic/genetic testing

0011M

Molecular diagnostic/genetic testing

0012M

Molecular diagnostic/genetic testing

0012U

Molecular diagnostic/genetic testing

0013M

Molecular diagnostic/genetic testing

0013U

Molecular diagnostic/genetic testing

0014U

Molecular diagnostic/genetic testing

0016M

Inpatient Only Code

00176

Anesth pharyngeal surgery

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0017M

Molecular diagnostic/genetic testing

0017U

Transplant surgeries

0018M

Preauthorization requests will be reviewed by Humana National Transplant Network GÇó Submit by fax to 1-502-508-9300 GÇó Submit by telephone to 1-866-421-5663 GÇó Submit by email to transplant@humana.com

Molecular diagnostic/genetic testing

0018U

Inpatient Only Code

00192

Anesth facial bone surgery

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0019U

Inpatient Only Code

00211

Anesth cran surg hemotoma

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00214

Anesth skull drainage

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00215

Anesth skull repair/fract

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0021U

Molecular diagnostic/genetic testing

0022U

Molecular diagnostic/genetic testing

0026U

Molecular diagnostic/genetic testing

0029U

Molecular diagnostic/genetic testing

0030U

Molecular diagnostic/genetic testing

0031U

Molecular diagnostic/genetic testing

0032U

Molecular diagnostic/genetic testing

0033U

Molecular diagnostic/genetic testing

0036U

Molecular diagnostic/genetic testing

0037U

Molecular diagnostic/genetic testing

0045U

Inpatient Only Code

00474

Anesth surgery of rib

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0047U

Molecular diagnostic/genetic testing

0048U

Molecular diagnostic/genetic testing

0049U

Molecular diagnostic/genetic testing

0050U

Inpatient Only Code

00524

Anesth chest drainage

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0053U

Inpatient Only Code

00540

Anesth chest surgery

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00542

Anesthesia removal pleura

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00546

Anesth lung chest wall surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0055U

Inpatient Only Code

00560

Anesth heart surg w/o pump

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00561

Anesth heart surg <1 yr

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00562

Anesth hrt surg w/pmp age 1+

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00567

Anesth cabg w/pump

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0056U

Inpatient Only Code

00580

Anesth heart/lung transplnt

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00604

Anesth sitting procedure

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0060U

Inpatient Only Code

00632

Anesth removal of nerves

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0067U

Molecular diagnostic/genetic testing

0069U

Molecular diagnostic/genetic testing

0070U

Molecular diagnostic/genetic testing

0071U

Molecular diagnostic/genetic testing

0072U

Molecular diagnostic/genetic testing

0073U

Molecular diagnostic/genetic testing

0074U

Inpatient Only Code

0075T

Perq stent/chest vert art

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0075U

Inpatient Only Code

0076T

S&i stent/chest vert art

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0076U

Molecular diagnostic/genetic testing

0078U

Inpatient Only Code

00792

Anesth hemorr/excise liver

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00794

Anesth pancreas removal

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00796

Anesth for liver transplant

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0079U

Inpatient Only Code

00844

Anesth pelvis surgery

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00846

Anesth hysterectomy

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00848

Anesth pelvic organ surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00864

Anesth removal of bladder

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00866

Anesth removal of adrenal

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00868

Anesth kidney transplant

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Transplant surgeries

0087U

Preauthorization requests will be reviewed by Humana National Transplant Network GÇó Submit by fax to 1-502-508-9300 GÇó Submit by telephone to 1-866-421-5663 GÇó Submit by email to transplant@humana.com

Inpatient Only Code

00882

Anesth major vein ligation

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0154U

Molecular diagnostic/genetic testing

0155U

Molecular diagnostic/genetic testing

0156U

Molecular diagnostic/genetic testing

0157U

Transplant surgeries

0088U

Preauthorization requests will be reviewed by Humana National Transplant Network GÇó Submit by fax to 1-502-508-9300 GÇó Submit by telephone to 1-866-421-5663 GÇó Submit by email to transplant@humana.com

Molecular diagnostic/genetic testing

0089U

Inpatient Only Code

00904

Anesth perineal surgery

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00908

Anesth removal of prostate

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0090U

Inpatient Only Code

00932

Anesth amputation of penis

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00934

Anesth penis nodes removal

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

00936

Anesth penis nodes removal

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0094U

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0095T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0098T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0101U

Molecular diagnostic/genetic testing

0102U

Molecular diagnostic/genetic testing

0103U

Molecular diagnostic/genetic testing

0111U

Inpatient Only Code

01140

Anesth amputation at pelvis

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01150

Anesth pelvic tumor surgery

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0120U

Inpatient Only Code

01212

Anesth hip disarticulation

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01232

Anesth amputation of femur

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01234

Anesth radical femur surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01272

Anesth femoral artery surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01274

Anesth femoral embolectomy

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0129U

Molecular diagnostic/genetic testing

0130U

Molecular diagnostic/genetic testing

0131U

Molecular diagnostic/genetic testing

0132U

Molecular diagnostic/genetic testing

0133U

Molecular diagnostic/genetic testing

0134U

Molecular diagnostic/genetic testing

0135U

Molecular diagnostic/genetic testing

0136U

Molecular diagnostic/genetic testing

0137U

Molecular diagnostic/genetic testing

0138U

Inpatient Only Code

01404

Anesth amputation at knee

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01442

Anesth knee artery surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01444

Anesth knee artery repair

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01502

Anesth lwr leg embolectomy

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0153U

Molecular diagnostic/genetic testing

0158U

Molecular diagnostic/genetic testing

0159U

Molecular diagnostic/genetic testing

0160U

Molecular diagnostic/genetic testing

0161U

Molecular diagnostic/genetic testing

0162U

Inpatient Only Code

01634

Anesth shoulder joint amput

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01636

Anesth forequarter amput

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0164T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01652

Anesth shoulder vessel surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01654

Anesth shoulder vessel surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Inpatient Only Code

01656

Anesth arm-leg vessel surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0165T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0169U

Molecular diagnostic/genetic testing

0170U

Molecular diagnostic/genetic testing

0171U

Molecular diagnostic/genetic testing

0172U

Molecular diagnostic/genetic testing

0173U

Inpatient Only Code

01756

Anesth radical humerus surg

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0175U

Molecular diagnostic/genetic testing

0177U

Molecular diagnostic/genetic testing

0179U

Molecular diagnostic/genetic testing

0195U

Inpatient Only Code

01990

Support for organ donor

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0202T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0203U

Molecular diagnostic/genetic testing

0204U

Molecular diagnostic/genetic testing

0205U

Molecular diagnostic/genetic testing

0208U

Molecular diagnostic/genetic testing

0209U

Molecular diagnostic/genetic testing

0211U

Molecular diagnostic/genetic testing

0212U

Facet injections

0213T

Molecular diagnostic/genetic testing

0213U

Facet injections

0214T

Molecular diagnostic/genetic testing

0214U

Facet injections

0215T

Molecular diagnostic/genetic testing

0215U

Facet injections

0216T

Molecular diagnostic/genetic testing

0216U

Facet injections

0217T

Molecular diagnostic/genetic testing

0217U

Facet injections

0218T

Molecular diagnostic/genetic testing

0218U

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0219T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0220T

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0221T

Spinal fusion, decompression, kyphoplasty and vertebroplasty

0222T

Molecular diagnostic/genetic testing

0229U

Molecular diagnostic/genetic testing

0230U

Molecular diagnostic/genetic testing

0231U

Molecular diagnostic/genetic testing

0232U

Molecular diagnostic/genetic testing

0233U

Molecular diagnostic/genetic testing

0234U

Inpatient Only Code

0235T

Trluml perip athrc visceral

HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only

Molecular diagnostic/genetic testing

0235U

Molecular diagnostic/genetic testing

0236U

Molecular diagnostic/genetic testing

0237U

Molecular diagnostic/genetic testing

0238U

Molecular diagnostic/genetic testing

0239U

Molecular diagnostic/genetic testing

0242U

Molecular diagnostic/genetic testing

0244U

Molecular diagnostic/genetic testing

0245U

Molecular diagnostic/genetic testing

0250U

Molecular diagnostic/genetic testing

0252U

Micro Invasive Glaucoma Surgery (MIGs)

0253T

Molecular diagnostic/genetic testing

0253U

Molecular diagnostic/genetic testing

0254U

Molecular diagnostic/genetic testing

0258U

Molecular diagnostic/genetic testing

0260U

Molecular diagnostic/genetic testing

0262U

Molecular diagnostic/genetic testing

0264U

Humana

Prior Authorization Required Code List

If service or procedure is being performed inpatient, prior authorization is required

Prior authorization is NOT required when drug administered as an Inpatient or in the ED or Urgent Care Clinic

All chemotherapy drugs require prior authorization

Effective date: Dec 1, 2023

Humana

Prior Authorization Required Code List

***If service or procedure is being performed inpatient, prior authorization is required***

***Prior authorization is NOT required when drug administered as an Inpatient or in the ED or Urgent Care Clinic***

***All chemotherapy drugs require prior authorization***

Effective date: Dec 1, 2023

If service or procedure is being performed inpatient, prior authorization is required

Prior authorization is NOT required when drug administered as an Inpatient or in the ED or Urgent Care Clinic

All chemotherapy drugs require prior authorization