Implantable Devices
Governs Humana's criteria and reimbursement policy for items considered implantable devices for Medicare Advantage and Commercial products; affects providers submitting claims for implantable items.
No material clinical or coverage changes in this revision.
Reimbursement Criteria for Implantable Devices
Reimbursement criteria for implantable devices
Covered as an implantable device only when ALL of the following are met:
ALL of the following
- Item is of a type that is implanted (examples include: a piece of tissue, a tooth, a pellet of medicine, a tube or needle containing a radioactive substance, a graft, or an insert; liquid and solid plastic materials used to augment tissues or to fill in areas traumatically or surgically removed; stents; artificial joints; shunts; pins; plates; screws; anchors).
- Claim and item meet applicable plan requirements, including medical necessity and reasonableness, and any applicable referral or authorization requirements.
- Subject to provider contract terms and any other applicable limitations.
- Documentation that supports the item meets Humana's definition of an implantable device is available upon Humana request (e.g., itemized bills, invoices, medical records).
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