Updates to the lists include the following:
- Preauthorization will be required for peripheral revascularization (atherectomy, angioplasty), ablation (bone, liver, kidney, prostate), thyroid surgeries (thyroidectomy and lobectomy) for commercial fully insured, MA and dual Medicare-Medicaid plans. Preauthorization requests will be reviewed by HealthHelp. To search services or procedures,
- Preauthorization will be required for capsule endoscopy and noninvasive home ventilators for commercial fully insured, MA and dual Medicare-Medicaid plans. Preauthorization requests will be reviewed by Humana.
- Preauthorization will be required for decompression of peripheral nerve (i.e., carpal tunnel surgery), EGD endoscopy (patients 59 and younger only, includes site-of-service evaluation) and gastric pacing for commercial fully insured plans. Preauthorization requests will be reviewed by Humana.
- Preauthorization for medications delivered in the physician’s office, clinic, outpatient or home setting is expanding to include all medications noted with an asterisk (*) on the preauthorization lists posted on Humana.com/PAL.
- The Centers for Medicare & Medicaid Services (CMS) rescinded its September 2012 memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services,” which allows Medicare Advantage plans to apply step therapy for physician-administered and other Part B drugs. Due to this recent change, Humana will require review of some injectable drugs and biologics for step therapy requirements in addition to current review requirements. The affected drugs and biologics are indicated on Humana’s preauthorization and notification lists for Humana commercial, Medicare Advantage and dual Medicare-Medicaid plans with a (#) indicator.