CurrentHumanaPolicy CP2016005

Itemized Bill Review for Inpatient Routine Services

Humana's claims payment guideline describing when itemized bills for inpatient facility claims may be requested and which routine items, supplies and services are generally not separately billable; applies to providers submitting claims for Medicare Advantage, Commercial and Medicaid products.

Policy Summary

PayerHumana

PolicyItemized Bill Review for Inpatient Routine Services

Policy CodePolicy CP2016005

Change TypeNo material change

Effective Date

Next Review Date

Key ActionHumana may request an itemized bill for an inpatient facility claim to verify that billed revenue codes represent charges for appropriately billed items, supplies and services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

MA, Commercial, MedicaidProducts covered

06/2016; 08/2022Document dates

CP2016005Policy ID

Routine not separately billableCoverage stance

Itemized Bill Review and Non-Separately Billable Items

Itemized bill review and non-separately billable items

Humana may request and review an itemized bill to determine if items billed separately during an inpatient admission are appropriately billed and payable separately from the room and board charge.

Humana may request an itemized bill for an inpatient facility claim to verify that billed revenue codes represent charges for appropriately billed items, supplies and services.

Revenue codes are categorical and do not describe exact items, supplies and services provided during an inpatient admission; an itemized bill may be requested to validate separate billability.

To separately bill items, supplies and services rendered during an inpatient hospital encounter, the provider must consistently follow its customary charging practice for all patients and payers.

Claims payments remain subject to other plan requirements, including medical necessity, reasonableness and applicable referral/authorization requirements; Medicaid reviews follow state Medicaid agency requirements.

Policy Summary

PayerHumana

PolicyItemized Bill Review for Inpatient Routine Services

Policy CodePolicy CP2016005

Change TypeNo material change

Effective Date

Next Review Date

Key ActionHumana may request an itemized bill for an inpatient facility claim to verify that billed revenue codes represent charges for appropriately billed items, supplies and services.

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.

ALL of the following

Examples of non-separately billable items/services
- Any supplies, items and services that, under customary charging practices, are included in charges for a specific service or in charges for the delivery of services in a specific location (e.g., bandages, inpatient admission kits; included services such as 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 (applies to all inpatient types, including specific treatment areas such as NICU or CCU) — examples include cardiac monitors and DME items used while inpatient.

Itemized Bill Requests and Plan Requirements

Documentation Required

Itemized bill may be requested to verify separate billability

Humana may request an itemized bill for an inpatient facility claim to verify that billed revenue codes represent charges for appropriately billed items, supplies and services; routine items already included in the primary inpatient room and board charge are not separately billable.

Purpose: to verify that revenue codes correspond to separately billable items, supplies and services.
Routine inpatient items, supplies and services included in the room and board charge should not be billed separately.

Denial Risk

Claims subject to other plan and state Medicaid requirements

Claims payments remain subject to other plan requirements for processing and payment, including medical necessity, reasonableness and any applicable referral or authorization rules; Humana Medicaid reviews follow state Medicaid agency requirements.

Medicare Advantage and Commercial: payments subject to medical necessity, reasonableness and referral/authorization requirements.
Medicaid: inpatient itemized bill reviews follow applicable state Medicaid agency requirements.

Key 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.

ScopeApplies to how providers classify items/services for billing across all patients; used to assess whether separate billing is appropriate.

Relevance to reviewsHumana may consider customary charging practices when reviewing itemized bills to determine if billed items are appropriately classified and payable separately.

Room and board charge

DefinitionInpatient routine services included by the provider in a daily service charge (the room and board charge) rather than billed separately.

Typical componentsRoom, dietary and nursing services; minor medical and surgical supplies; medical social services; psychiatric social services; use of certain equipment and facilities for which a separate charge is not payable.

Billing implicationServices included in the room and board charge are generally not separately payable and may be disallowed if billed separately during an inpatient admission.

Routine (inpatient)

DefinitionInpatient routine services included in the daily service (room and board) charge; these are services commonly bundled into the daily facility charge.

ExamplesRoom, dietary and nursing services; minor medical and surgical supplies; medical social services; psychiatric social services; use of certain equipment and facilities for which a separate charge is generally not payable.

Payment guidanceRoutine services listed are generally not separately billable and Humana may request an itemized bill to verify separate billability.

OpenPayer

Itemized Bill Review for Inpatient Routine Services

Itemized Bill Review and Non-Separately Billable Items

Revenue Code Guidance

Itemized Bill Requests and Plan Requirements

Key Definitions