More About Our Edits
These edits are being added in order to comply with the final Health Insurance Portability and Accountability Act (HIPAA) rule, which named the ICD-9-CM Volume 3 Procedure Codes (including The Official ICD-9-CM Guidelines for Coding and Reporting) as the HIPAA standard medical code set for inpatient hospital services, and the HCPCS/CPT codes as the HIPAA standard medical code set for physician services and other health care services (including outpatient hospital procedures). With the implementation of these edits, Humana will:
- No longer accept outpatient hospital claims with ICD-9-CM Vol 3 procedure codes in either or both the Procedure Information segment (BQ) or Other Procedure Information (BR). Humana will follow the HIPAA standard medical code set of HCPCS/CPT codes for outpatient services. Humana's rejection message will state, "ICD-9 valid only for hospital inpatient bill types."
- No longer accept an inpatient hospital claim with a HCPCS/CPT code in either or both the Procedure Information segment (BP) or Other Procedure Information (BO). Humana's rejection message will state, "ICD-9 must be used for hospital inpatient reporting."
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April 24, 2012, Facility Claim Code Edits
Humana will be updating our claim payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards regarding facility claims.
- All markets (excluding Puerto Rico)
- (246 KB) Download PDF
- English
- Puerto Rico Only
- (293 KB) Download PDF
- English
April 14, 2012, Claim Code Edits
Humana will be updating our claim payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards regarding physician/health care provider claims.
- All markets (excluding Puerto Rico)
- (166 KB) Download PDF
- English
- Puerto Rico Only
- (135 KB) Download PDF
- English
January 31, 2012, Facility Claim Code Edits
Humana will be updating our claim payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards regarding facility claims.
- All markets (excluding Puerto Rico)
- (181 KB) Download PDF
- English
- Puerto Rico Only
- (112 KB) Download PDF
- English
January 23, 2012, Claim Code Edits
Humana will be updating our claim payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards regarding physician/health care provider claims.
- All markets (excluding Puerto Rico)
- (100 KB) Download PDF
- English
- Puerto Rico only
- (324 KB) Download PDF
- Spanish
November 29, 2011, Outpatient Facility Claim Code Edits
Humana is updating its claims payment system for outpatient facilities only. These updates support Humana's continuing efforts to process claims accurately. We're updating our claim code-editing logic in relation to several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets. Please note: These updates do not affect physician claims.
- Outpatient Facility Claim Code Edits
- (307 KB) Download PDF
- English
- Puerto Rico Only
- (320 KB) Download PDF
- Spanish
November 5, 2011, Claim Code Edits
Humana will be updating our claim payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards regarding physician/health care provider claims.
- All markets (excluding Puerto Rico)
- (125 KB) Download PDF
- English
- Puerto Rico Only
- (310 KB) Download PDF
- Spanish
June 24, 2011, Claims Policy Change and Claim Code Edits
View a list of modifications to Humana's claims payment policies that support Humana's continuing efforts to process claims fairly, accurately and appropriately. We're updating our claim code-editing logic in several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
- All markets (excluding Puerto Rico)
- (150 KB) Download PDF
- English
- Puerto Rico Only
- (76 KB) Download PDF
- Spanish
June 7, 2011, Outpatient Facility Claim Code Edits
View a list of modifications to Humana's claims payment system for outpatient facilities only. These updates support Humana's continuing efforts to process claims accurately. We're updating our claim code-editing logic in relation to several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets. Please note: These updates do not affect physician claims.
- Outpatient Facility Claim Code Edits
- (337 KB) Download PDF
- English
- Puerto Rico Only
- (337 KB) Download PDF
- Spanish
June 7, 2011, Inpatient Facility Claim Code Edits
View a list of modifications to Humana's claims payment system for inpatient facilities only. Please note: These updates do not affect physician claims.
- Inpatient Facility Claim Code Edits
- (148 KB) Download PDF
- English
April 10, 2011, Claim Code Edits
View a list of modifications to Humana's claims payment policies that support Humana's continuing efforts to process claims fairly, accurately and appropriately. We're updating our claim code-editing logic in several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
- All markets (excluding Puerto Rico)
- (304 KB) Download PDF
- English
- Puerto Rico Only
- (314 KB) Download PDF
- Spanish
January 22, 2011, Claim Code Edits
View a list of updates to Humana's claim code-editing software that affects several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
- All markets (excluding Puerto Rico)
- (28 KB) Download PDF
- English
- Puerto Rico Only
- (268 KB) Download PDF
- Spanish
November 30, 2010, Outpatient Facility Claim Code Edits
View a list of modifications to Humana's claims payment system for outpatient facilities only. These updates support Humana's continuing efforts to process claims accurately. We're updating our claim code-editing logic related to several areas, including the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets. Please note: These updates do not affect physician claims.
- All Markets (excluding Puerto Rico)
- (465 KB) Download PDF
- English
- Puerto Rico Only
- (575 KB) Download PDF
- Spanish
November 6, 2010, Claim Code Edits
View a list of modifications to Humana's claims payment policies that support Humana's continuing efforts to process claims fairly, accurately and appropriately. We're updating our claim code-editing logic in several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
All markets (excluding Puerto Rico)
- All Markets (excluding Puerto Rico)
- (84 KB) Download PDF
- English
- Puerto Rico Only
- (308 KB) Download PDF
- Spanish
July 10, 2010, Outpatient Facility Claim Code Edits
View a list of modifications to Humana's claims payment system for outpatient facilities only. These updates support Humana's continuing efforts to process claims accurately. We’re updating our claim code-editing logic in several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets. Please note: These updates do not affect physician claims.
- Outpatient Facility Claim Code Edits
- (84 KB) Download PDF
- English
April 24, 2010, Claim Code Edits
View a list of modifications to Humana’s claims payment policies that support Humana’s continuing efforts to process claims fairly, accurately and appropriately. We're updating our claim code-editing logic in several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
- All markets (excluding Puerto Rico)
- (84 KB) Download PDF
- English
January 24, 2010 Claim Code Edits
View a list of modifications to Humana’s claim payment policies to support our continuing efforts to process claims fairly, accurately and appropriately. We are updating our claim code-editing logic in several areas associated with the American Medical Association (AMA) Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
Additional enhancements allow Humana to apply coverage determinations specifically by region, which will facilitate current and consistent application of NCDs/LCDs in claim adjudication.
- January 24, 2010 Claim Code Edits
- (40 KB) Download PDF
- English
January 24, 2010 – No Benefit Codes – Commercial and Medicare products
View lists of codes for services that will not be covered effective January 24, 2010.
- Commercial
- (74 KB) Download PDF
- English
- Medicare HMO
- (65 KB) Download PDF
- English
- Medicare PPO
- (58 KB) Download PDF
- English
- Medicare PFFS
- (56 KB) Download PDF
- English
October 27, 2009 Claim Code Edits
View a list of modifications to Humana’s claims payment policies that support Humana's continuing efforts to process claims fairly, accurately and appropriately. We’re updating our claim code-editing logic in several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
- October 27, 2009 Claim Code Edits
- (17.9 KB) Download PDF
- English
June 30, 2009, Claim Code Edits
View a list of modifications to Humana's orthotic, prosthetic and durable medical equipment claims payment policies to reflect nationally and regionally accepted standards, including the following:
- National and regional Centers for Medicare & Medicaid Services (CMS) coverage decisions
- Durable Medical Equipment Medicare Administrative Contractor (DME MAC) manual
- Healthcare Common Procedure Coding System (HCPCS) definitions
- Appropriate modifier usage (e.g., anatomic modifiers, functional modifiers, etc.)
- June 30, 2009, Claim Code Edits
- (44 KB) Download DOC
- English | Spanish
November 29, 2008, Claim Code Edits
View a list of updates to Humana's claim code-editing software that affects several areas of the American Medical Association (AMA) Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets.
- November 29, 2008, Claim Code Edits
- (44 KB) Download DOC
- English
Significant Edits
View a list of edits that affect at least 500 claims per year and differ from AMA CPT or CCI coding guidelines.
- Significant Edits
- (20.2 KB) Download PDF
- English
Modifier 59 Edits
View a list of code combinations that Humana has determined are not appropriately reported together with a modifier 59 and which differ from AMA CPT coding guidelines.
- Modifier 59 Edits
- (17.9 KB) Download PDF
- English
