CurrentHumanaPolicy CP2016005

Itemized Bill Review for Inpatient Routine Services

Defines Humana's review and payment approach for itemized inpatient facility bills to determine whether supplies, items and services are separately billable from the room and board charge; applies to Medicare Advantage and Medicaid products and participating providers.

Policy Summary

PayerHumana

PolicyItemized Bill Review for Inpatient Routine Services

Policy CodePolicy CP2016005

Change TypeNo material changes

Effective Date06/2016

Next Review Date

Key ActionHumana may request an itemized bill and requires providers to follow customary charging practices for all patients to separately bill inpatient items.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Medicare & MedicaidProducts

CP2016005Document ID

06/2016; 05/2026Published/Revised

Routine not separately billableCoverage Stance

Coverage criteria for inpatient itemized bill reviews

Humana reviews inpatient itemized bills and will not separately pay for items that are considered routine or included in the room and board charge. Payments are subject to plan requirements (medical necessity, reasonableness, referral/authorization) and applicable state Medicaid rules.

Humana may review an inpatient itemized bill to determine whether billed revenue codes represent charges for separately billable items, supplies and services.

Payments are subject to other plan requirements including medical necessity, reasonableness, and applicable referral/authorization requirements (Medicare Advantage); Medicaid reviews follow applicable state Medicaid agency requirements.

ALL of the following

To separately bill items, supplies and services rendered during an inpatient hospital encounter, the provider must consistently follow its customary charging practices for all Medicare and non-Medicare patients and all payers/health plans.

ALL of the following

Policy Summary

PayerHumana

PolicyItemized Bill Review for Inpatient Routine Services

Policy CodePolicy CP2016005

Change TypeNo material changes

Effective Date06/2016

Next Review Date

Key ActionHumana may request an itemized bill and requires providers to follow customary charging practices for all patients to separately bill inpatient items.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Examples (not exhaustive)
- Any supplies, items and services that under customary charging practices are included in charges for a specific service or in charges for delivery of services in a specific location (e.g., bandages; inpatient admission kits; IV flushing; dressing changes; equipment monitoring; routine nursing care and assessments).
- All items and supplies that may be purchased over the counter (e.g., personal care items, ice packs, alcohol wipes, cotton balls).
- All reusable items, supplies and equipment that are provided to all patients on a routine basis during an inpatient admission, including items used in specific treatment areas (e.g., cardiac monitors, DME items used while inpatient).

Claim form, revenue codes, and charging practice

Claim form and revenue codesmixed

UB-04 / CMS-1450

Facility claim form requiring revenue codes to describe services

Customary charging practice requirement

RequirementProvider must consistently follow its customary charging practices for all Medicare and non-Medicare patients, for all payers and health plans to separately bill items, supplies and services rendered during an inpatient encounter.

ScopeApplies to separately billing items on inpatient facility claims when Humana reviews an itemized bill to verify separate billability.

Applicability to payersMust be followed for all payers and health plans (Medicare and non‑Medicare).

PurposeEnsures billed revenue codes represent charges for appropriately billed items rather than routine services included in room and board.

Itemized bill requests and provider billing requirements

Denial Risk

Provide itemized bill and follow customary charging practices or risk denial

Humana may request an itemized bill for an inpatient facility (UB‑04/CMS‑1450) claim to verify that billed revenue codes represent charges for appropriately billed items, supplies and services. Providers who wish to separately bill inpatient items must consistently follow their customary charging practices for all Medicare and non‑Medicare patients and all payers; failure to do so may result in denial of separate payment when items are considered routine or included in the room and board charge.

Humana may request an itemized bill to verify revenue code entries represent separately billable items (UB‑04/CMS‑1450).
Provider must follow customary charging practices consistently for all patients and payers to separately bill inpatient items; inconsistent practices risk nonpayment.
Routine items, supplies and services included in the primary inpatient room and board charge are not separately billable and may be denied if billed separately.

Definitions

Customary charging practices

DefinitionA provider's common or established practice for classifying a particular item or service that is consistently followed for all patients and does not result in an inequitable apportionment of cost to the Medicare Program.

Consistency expectationCustomary charging practices must be applied uniformly to Medicare and non‑Medicare patients.

FunctionUsed to determine whether an item or service is separately billable or included in routine charges such as room and board.

Room and board charge

DefinitionInpatient routine services included by the provider in a daily service charge (the room and board charge), which may be referred to as the general room and board or primary service charge.

Typical componentsIncludes the room, dietary and nursing services, minor medical and surgical supplies, medical social services and psychiatric social services.

Included useIncludes the use of certain equipment and facilities for which a separate charge is not payable.

Routine (inpatient routine services)

DefinitionInpatient routine services generally are those services included by the provider in a daily service charge (room and board) for which a separate charge is generally not payable.

Examples of routine servicesRoom, dietary and nursing services; minor medical and surgical supplies; medical social services; psychiatric social services.

Examples of non‑separately billable itemsBandages, inpatient admission kits, IV flushing, dressing changes, equipment monitoring, routine nursing care and assessments, over‑the‑counter personal care items and routinely provided reusable equipment (e.g., cardiac monitors, DME used while inpatient).