CurrentHumanaPolicy CP2026004

Time-Based Service Codes

Reimbursement policy governing how Humana processes and limits units for time-based service codes for Kentucky Medicaid providers.

Policy Summary

PayerHumana

PolicyTime-Based Service Codes

Policy CodePolicy CP2026004

Change TypeNo material change

Effective Date03/2026

Next Review Date

Key ActionEnsure claims adhere to plan requirements including medical necessity and any applicable referral or authorization requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24-hour periodmaximum units per date of service cannot exceed

Kentucky Medicaidapplicability / program

CP2026004policy identifier

03/2026published date

Unit limitation rules

Humana allows units for time-based service codes subject to the following limitations, taking the lesser of:

ALL of the following

ONE of
- The limitation outlined in any applicable Centers for Medicare & Medicaid Services (CMS) policy or guidance.
- The limitation outlined in any applicable Kentucky Department for Medicaid Services (KDMS) policy or guidance.
- The limitation outlined in any applicable Humana policy or guidance, including but not limited to the Humana Healthy Horizons in Kentucky Policies Booklet.
- For each date of service, no more than the maximum number of units that equals a single 24‑hour period.

Policy Summary

PayerHumana

PolicyTime-Based Service Codes

Policy CodePolicy CP2026004

Change TypeNo material change

Effective Date03/2026

Next Review Date

Key ActionEnsure claims adhere to plan requirements including medical necessity and any applicable referral or authorization requirements.

SourceLink

On This Page

Time-based service codes and limits

Time-based service codes (examples)mixed

No codes listed

Maximum units per date of service

Maximum units per date of serviceFor each date of service, no more than the maximum number of units that equals a single 24‑hour period (take the lesser of this limit and applicable CMS/KDMS/Humana guidance)

CMS guidance limitThe limitation outlined in any applicable Centers for Medicare & Medicaid Services (CMS) policy or guidance

KDMS guidance limitThe limitation outlined in any applicable Kentucky Department for Medicaid Services (KDMS) policy or guidance

Humana policy limitThe limitation outlined in any applicable Humana policy or guidance, including the Humana Healthy Horizons in Kentucky Policies Booklet

Authorization and plan requirements

Prior Authorization

Authorization and plan requirements

Claims payments are processed only when plan requirements are met; this includes meeting medical necessity and reasonableness standards and any applicable referral or authorization requirements specified by the plan. Providers should confirm and obtain required referrals or authorizations before submitting claims to avoid payment delays or denials.

Payments are subject to medical necessity and reasonableness requirements.
Payments are subject to applicable referral or authorization requirements.

Time-based service codes — definitions

Time-based service codes

DefinitionTime-based service codes are used by providers to document and bill for services that are measured and reimbursed according to the amount of time spent delivering the service.

ExamplesIncludes prolonged services and certain evaluation and management (E/M), therapy, and care management services.

PurposeEnable reimbursement based on documented time units for services where duration determines payment.