Important Information Regarding Inpatient-only Procedures for Humana Medicare Members
The Centers for Medicare & Medicaid Services (CMS) uses an inpatient-only list to define procedures that should be performed on an inpatient basis for the Medicare population due to one or more of the following reasons:
- Nature of the procedure
- Need for at least 24 hours of postoperative care
- Underlying physical condition of those patients most oftenhaving the particular procedure
CMS created the list of American Medical Association (AMA) Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes as a payment policy for services for which it would not reimburse if performed as an outpatient. As a result, these services are only paid when provided in an inpatient setting. Humana Medicare Advantage plans follow these guidelines.
The list is available at: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html
Please review the list before scheduling any outpatient procedures, as Humana cannot provide payment for procedures that have been designated “inpatient only.”
