Notification Number: 1419
Effective date: 1/31/2012
Notification date: 10/31/2011
Topic: Supplies and Equipment Included in Room and Board
Hospitals should report AMA CPT codes consistent with their descriptors, CPT book instructions and correct coding principles. Infusions and injections are outpatient CPT codes and are paid under the Medicare outpatient prospective payment system (OPPS) for outpatient services. Administration of infusions and injections that a patient receives in a hospital room, neonatal intensive care unit (NICU) or intensive care unit (ICU) are considered routine care, are included in the room and board for the inpatient claim, and are not meant to be reported separately. These outpatient services will no longer be reimbursed when submitted on inpatient claims.
For a list detailing Humana’s guidelines for routine supplies for inpatient facilities, please visit: Humana’s Guidelines for Routine Supplies .
This notification applies to inpatient facilities.
Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements are still applicable. Modifiers should be used when appropriate to accurately represent the services rendered. The use of modifiers may impact Humana’s application of these edits. For additional information, consult professional coding resources.
*All edits previously posted on Humana.com/providers for fully insured commercial Humana members may be applied to self-funded members, when requested by the self-funded group.