Notification Number: 449
Effective date: 7/7/2011
Notification date: 4/8/2011
Category: Correct Coding
Topic: Supplies and Equipment Included in Inpatient Operating Room
Individual surgery items and equipment or supplies used in the operating room will not be reimbursed.
According to CMS and Humana payment policies, routine equipment or supplies (e.g., gowns, gloves, etc.) are not separately reimbursable. These items are included in the reimbursement for the inpatient operating room.
Additionally, the following individual surgery items are not separately reimbursable from surgery packs:
For a list detailing Humana’s guidelines for routine supplies for inpatient facilities, please visit: Humana’s Guidelines for Routine Supplies.
This edit will only be applied after a detailed review of the claim. 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.