CurrentHumanaPolicy N/A

Humana Dual Fully Integrated Illinois Long-Term Services and Supports (LTSS) Prior Authorization and Notification List

Governs prior authorization and notification requirements for long-term services and supports (LTSS) benefits for Humana Dual Fully Integrated Illinois members, covering specified services and associated billing codes.

Policy Summary

PayerHumana

PolicyHumana Dual FIDA-IL LTSS Prior Authorization and Notification List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization or notify for listed LTSS services (for example: adult day care, home healthcare, home modifications, respite, and specialized medical equipment).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

11distinct service lines listed

$26,000home modification limit

2026-01-01effective date

2026-02-05last revision

LTSS Prior Authorization and Notification List

LTSS Prior Authorization / Notification List

Services and associated billing codes on the LTSS prior authorization/notification list:

Covered services listed below require prior authorization or notification as indicated by the Humana Dual Fully Integrated Illinois LTSS Prior Authorization and Notification List.

Services

Adult day care (includes transportation) — Codes: S5100, T2003.
Automatic medication dispenser — Code: T1505.
Behavioral health services (master's or doctorate) — Code: H0004.

Policy Summary

PayerHumana

PolicyHumana Dual FIDA-IL LTSS Prior Authorization and Notification List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization or notify for listed LTSS services (for example: adult day care, home healthcare, home modifications, respite, and specialized medical equipment).

SourceLink

On This Page

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Service Codes and Benefit Limits

LTSS service codesmixed

S5100	Adult day care
T2003	Adult day care - transportation
T1505	Automatic medication dispenser
H0004	Behavioral health services
T2014	Habilitation day services
T2019	Prevocational services
T2020	Supported employment
S5170	Home-delivered meals
G0151	Home health aide or related home healthcare
G0152	Home health skilled services

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Home modification dollar limit

Home modification dollar limit$26,000 per service combined over a 3-year period.

ScopeApplies per service for home modifications (code S5165).

Benefit periodCombined maximum is calculated over a rolling 3-year period.

DocumentationRequests should reference the home modification description and applicable code S5165.

Provider Actions — Prior Authorization / Notification Items

Prior Authorization

Prior authorization required for adult day care (S5100, T2003)

Adult day care (includes transportation) is listed on the LTSS prior authorization/notification list and is associated with codes S5100 and T2003; providers must obtain prior authorization when billing these codes.

Codes: S5100, T2003

Prior Authorization

Prior authorization required for automatic medication dispenser (T1505)

Automatic medication dispenser is included on the prior authorization/notification list under code T1505; providers must secure prior authorization before billing this service.

Code: T1505

Prior Authorization

Prior authorization required for behavioral health services (H0004)

Behavioral health services provided by master's- or doctorate-level providers are subject to prior authorization and billed with code H0004; prior authorization must be obtained for coverage.

Code: H0004
Provider qualification: master's or doctorate level

Prior Authorization

Prior authorization required for habilitation / prevocational / supported employment

Habilitation day services, prevocational services, and supported employment are on the prior authorization/notification list and require prior authorization when billed with codes T2014, T2019, or T2020.

Codes: T2014, T2019, T2020

Prior Authorization

Prior authorization required for home-delivered meals (S5170)

Home-delivered meals are included on the prior authorization/notification list and require prior authorization when billed with code S5170.

Code: S5170

Prior Authorization

Prior authorization required for home healthcare services (home-based services)

Any home healthcare service provided in the member's home is included on the prior authorization/notification list and requires prior authorization when billed with the listed home health codes.

Codes: G0151, G0152, G0153, G0156, G0299, G0300, S5125, S5130, T1000, T1003, T1004

Prior Authorization

Prior authorization and dollar limit for home modifications (S5165)

Home modifications are subject to prior authorization and carry a benefit limit of a maximum $26,000 combined per service over a 3-year period; obtain prior authorization before proceeding.

Code: S5165
Limit: maximum $26,000 combined over a 3-year period (per service)

Prior Authorization

Prior authorization required for personal emergency response system (S5160, S5161)

Personal emergency response systems are on the prior authorization/notification list and require prior authorization when billed with codes S5160 or S5161.

Codes: S5160, S5161

Prior Authorization

Prior authorization required for respite services (T1005)

Respite services provided by a homemaker, licensed practical nurse, registered nurse, certified nursing assistant, or personal assistant are included on the prior authorization/notification list and require prior authorization when billed with code T1005.

Code: T1005
Eligible providers: homemaker, LPN, RN, CNA, or personal assistant

Prior Authorization

Prior authorization required for specialized medical equipment (T2028)

Specialized medical equipment (purchase or rental) is listed on the prior authorization/notification list and requires prior authorization when billed with code T2028.

Code: T2028
Applies to purchase or rental per service

Definitions and Provider Qualifications

Home modifications (benefit limit)

Benefit limit (per service)Home modification, per service - maximum $26,000 combined over a 3-year period.

Applicable codeS5165

Measurement periodCombined across services within a 3-year period.

Policy contextListed on the LTSS Prior Authorization and Notification List for Humana Dual Fully Integrated Illinois.

Behavioral health services (provider qualifications)

Provider qualificationBehavioral health services provided by master’s- or doctorate-level providers.

Applicable codeH0004

Service listingBehavioral health services are included on the LTSS Prior Authorization and Notification List.

Respite services (eligible providers)

Eligible provider typesRespite services may be provided by homemaker, licensed practical nurse (LPN), registered nurse (RN), certified nursing assistant (CNA), or personal assistant.

Applicable codeT1005

Service listingRespite services are included on the LTSS Prior Authorization and Notification List.