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Code edit notification

Notification Number: 357

Effective date: 11/9/2015

Notification date: 8/7/2015

Category: HCPCS - DMEPOS

Topic: Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) bundled to the inpatient admission

Providers affected:

  • Inpatient/Outpatient Facilities
  • Physician/Health Care Providers
What is changing?
Any code reported by a DME provider will not be eligible for reimbursement when the date of service falls after the admission date and prior to the discharge date for any inpatient admission.
Why is Humana implementing this change?

According to the CMS Medicare Claims Processing Manual, DMEPOS items are for use by a patient in his or her home. The institution is expected to provide all medically necessary DMEPOS items during a patient’s inpatient stay.

Impacted products

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


*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.