Notification Number: 3530
Effective date: 3/1/2018
Notification date: 12/1/2017
Topic: Therapy – group therapy
We will not reimburse charges for CPT code 97150, therapeutic procedure(s), group (two or more individuals).
Humana's policy on physical and occupational therapy has been updated to indicate that the services above are not covered.
For more information, refer to Humana's Medical and Pharmacy Coverage Policies page and search for “97150.”
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.