Humana Healthy Horizons in Louisiana Prior Authorization and Notification List (PAL)
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Defines services, procedures, devices, and medications that may require prior authorization or notification for Humana Healthy Horizons Medicaid members in Louisiana and explains how providers should request authorizations and notifications.
No material clinical or coverage changes in this revision.
Services and Categories Requiring Authorization or Notification
PAL Coverage Categories
Lists by category/subcategory with associated codes indicate services that generally require prior authorization or notification as specified in the PAL.
ALL of the following
- All psychiatric inpatient admissions (prior authorization or notification as applicable)
- Other behavioral health service codes subject to review (examples): H0039 (ACT/FACT), H0036 (CPST), H0019/H2034/H2036 (residential/substance use), H0011/H0012 (substance use disorder inpatient), H0015 (IOP), H2033 (MST), H0038 (peer support), H2013 (PRTF), psychological testing codes 96116, 96121, 96130-96131, 96132-96133, 96136-96139, 96146
ALL of the following
ALL of the following
- Gender-affirming and related genital/gynecologic procedures (examples: 54401-54417, 54520, 54660, 54690, 55175, 55180, 55899, 56625, 56800-56810, 57106-57111, 57291-57296, 57426, 58150, 58180, 58260-58294, 58541-58554, 58570-58573, 58661, 58720, 58940, 58999, C1789, C1813, C2622, L8600, L8699, S0189)
- Obesity/bariatric surgery codes (examples: 43644-43645, 43770-43775, 43843-43848, 43886-43888)
- Oral/orthognathic/TMJ surgeries (examples: 21208-21209)
- Transplant procedures and related codes (extensive list including 32850-32854, 33927-33929, 33935, 33945, 38205-38206, 38230, 38232, 38240-38243, 44135, 47133, 47135, 48160, 48550-48556, 50300-50370, 50547, 81370-81383, various T-codes and G-codes, L8698, S2053-S2054, S2060, S2065, S2102, S2142, 02WA3QZ, 02WA4QZ)
ALL of the following
ALL of the following
- Select cardiac implantable devices (example: 33274) and other cardiac device procedures
ALL of the following
- Urgent/emergent services do not require prior authorization or notification.
ALL of the following
- No prior authorization required for initial CBCS visit; prior authorization required for CBCS services beyond 16 units.
ALL of the following
- Obstetrical admissions: notify Humana when admission exceeds 48 hours for vaginal delivery or 96 hours for cesarean section to allow concurrent review and discharge planning.
- Crisis intervention/behavioral health crisis/mobile crisis: notify Humana within 48 to 72 hours to permit concurrent review and care coordination.
PAL-listed services requiring authorization/notification
The following procedure codes and service categories are listed in the PAL and are subject to Humana's prior authorization or notification requirements as indicated elsewhere in the policy.
Representative Codes and Code Groups
| H0039 | Assertive community treatment (ACT) and forensic ACT |
| H0036 | Community psychiatric supportive treatment (CPST) |
| H2011 | Crisis intervention (follow-up children/adolescents; adult crisis services/mobile crisis/BHCC follow-up/CBCS) |
| H0045 | (listed in PAL) |
| H0019 | (listed in PAL) |
| H0011 | (listed in PAL) |
| H0012 | (listed in PAL) |
| H0015 | Intensive outpatient program (IOP) |
| H2033 | Multisystemic therapy (MST) |
| H0038 | Peer support services |
| 15820-15823 | Blepharoplasty and related eyelid procedures |
| 67900-67950 | Eyelid/eyelid lesion procedures |
| 11920-11971 | Breast-related procedures |
| 19361-19396 | Breast surgery/procedures |
| E0466 | Noninvasive home ventilators |
| E2402 | Negative pressure wound therapy (NPWT) |
| E0747 | (listed in PAL) |
| E0748 | (listed in PAL) |
| E0483 | High-frequency chest compression vest |
| E0260 | Hospital bed |
| E0470 | Oxygen equipment |
| E2506 | Speech-generating device |
| E2508 | Speech-generating device |
| E2510 | Speech-generating device |
| 54401-54417 | Various penile prosthesis/related procedures listed in PAL |
| 54520 | Penile surgery-related |
| 54660 | Penile/urethral procedure listed |
| 54690 | Penile procedure listed |
| 55175 | Testicular procedure listed |
| 55180 | Testicular procedure listed |
| 55899 | Unlisted genitourinary procedure |
| 56625 | Vulvar/vaginal procedure |
| 56800-56810 | Vaginal/related procedures |
| 57106-57111 | Repair/reconstruction procedures of female genitalia |
| 43644-43645 | Bariatric sleeve/related procedures |
| 43770-43775 | Gastric bypass and banding procedures |
| 43843-43848 | Bariatric revision/other procedures |
| 43886-43888 | Bariatric-related procedures |
| 21208-21209 | Orthognathic and TMJ surgical procedure codes |
| 32850-32854 | Thoracic transplant-related procedure codes |
| 33927-33929 | Cardiac transplant/related procedures |
| 33935 | Cardiac procedure |
| 33945 | Cardiac procedure |
| 38205-38206 | Bone marrow harvest/collection |
| 38230, 38232 | Transplant-related hematopoietic cell collection/transplant codes |
| 38240-38243 | Stem cell/transplant procedures |
| 44135 | Small bowel resection/related |
| 47133, 47135 | Liver transplant related procedures |
| 48160 | Pancreas procedure |
How Providers Should Request Authorizations and Notifications
How to initiate prior authorization or notification
Except where noted, prior authorization requests for medical services may be initiated by accessing Availity Essentials online (registration required), calling Humana Healthy Horizons in Louisiana at 1-800-448-3810 (Monday–Friday, 7 a.m. to 7 p.m.), or faxing the prior authorization form to 1-833-974-0059. Behavioral health prior authorization requests may be initiated by calling the Behavioral Health Crisis Line at 1-844-461-2848.
- Availity Essentials online (registration required)
- Phone: 1-800-448-3810 (M–F, 7 a.m.–7 p.m.)
- Fax: 1-833-974-0059
- Behavioral health PA: Behavioral Health Crisis Line 1-844-461-2848
Notification vs prior authorization
Notification is a separate process in which a healthcare provider notifies Humana Healthy Horizons in Louisiana of the intent to provide an item or service; Humana does not issue an approval or denial related to a notification. Urgent/emergent services do not require prior authorization or notification.
- Notification is for care coordination and is not an approval/denial.
- Verify benefits and PA/notification requirements with Humana prior to providing services when in doubt.
Inpatient initiation of ECT requires prior authorization
Prior authorization is required for initiation of electroconvulsive therapy (ECT) when the member is an inpatient.
Obstetrical admission notification for extended stays
Humana Healthy Horizons expects providers to notify the plan for obstetrical admissions that exceed 48 hours for vaginal deliveries or 96 hours for cesarean sections to allow concurrent review and discharge planning.
- Notify when admission >48 hours (vaginal delivery).
- Notify when admission >96 hours (cesarean section).
Behavioral health crisis notification timeframe
For crisis intervention, behavioral health crisis care, and mobile crisis, Humana Healthy Horizons expects providers to notify the plan within 48 to 72 hours to permit concurrent review and care coordination.
- Notification window: within 48 to 72 hours of the crisis event.
- Allows Humana to conduct concurrent review and coordinate care.
Key Terms
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