About Us

Back To Claim Processing Edits 

 

Code edit notification

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

Providers affected:

  • Inpatient/Outpatient Facilities
What is changing?

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:

  • Routine supply items found in the “floor stock” that would generally be available to all patients receiving supplies in that location
  • It is not allowable to bill for either the cost of capital equipment or the rental of equipment owned by the inpatient facility.

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.

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.