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Code edit notification

Notification Number: 1419

Effective date: 1/31/2012

Notification date: 10/31/2011

Category: Incidental

Topic: Supplies and Equipment Included in Room and Board

Providers affected:

  • Inpatient/Outpatient Facilities
What is changing?

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.

Why is Humana implementing this change?
Humana periodically updates its policies and claims payment systems to be aligned with correct-coding initiatives as well as national benchmarks and industry standards.

Impacted products

  • Select self-funded* products
  • Commercial fully insured products
  • Medicare Advantage HMO products
  • Medicare Advantage PFFS products
  • Medicare Advantage PPO products

Disclaimer

*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.