Increased Procedural Services (Modifier 22)
Defines Humana's reimbursement approach for procedures billed with modifier 22 for Commercial and Medicare Advantage products; applies to professional services and guides documentation and payment review for additional reimbursement requests.
No material clinical or coverage changes in this revision.
Modifier 22 Coverage Criteria
Modifier 22 coverage criteria
Humana will consider additional reimbursement for services billed with modifier 22 only when the claim includes required documentation demonstrating unusual circumstances.
ALL of the following
- Concise statement describing how the service differed from the usual (must be submitted with the claim)
- Operative report included with the claim (must be submitted with the claim)
- Modifier 22 reported only with procedure codes that have a global period of 0, 10, or 90 days
- Modifier 22 should not be appended to E/M services
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