CurrentHumanaPolicy CP2026004

Time-Based Service Codes

Defines Humana's reimbursement rules for time-based service codes for Kentucky Medicaid providers, including limits on allowable units per date of service and applicable external guidance.

Policy Summary

PayerHumana

PolicyTime-Based Service Codes

Policy CodePolicy CP2026004

Change TypeNo material change

Effective Date03/2026

Next Review DateN/A

Key ActionWhen billing time-based service codes for Humana Kentucky Medicaid members, submit units no greater than the least restrictive limit among CMS guidance, KDMS guidance, Humana guidance, and the per-date-of-service 24-hour maximum.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Kentucky Medicaidapplicability jurisdiction

1maximum units per date of service equals single 24-hour period

4sources used to determine lesser limitation (CMS, KDMS, Humana, 24-hour cap)

Unit Allowance Decision Rule

Unit allowance decision rule for time-based service codes

Humana allows billed units at the lesser of the following limitations for each date of service.

ALL of the following

Limit is the lesser of the listed items (apply comparison across items)

ANY of the following

The limitation outlined in any applicable 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 Humana Healthy Horizons in Kentucky Policies Booklet)

Policy Summary

PayerHumana

PolicyTime-Based Service Codes

Policy CodePolicy CP2026004

Change TypeNo material change

Effective Date03/2026

Next Review DateN/A

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.

Time-Based Codes & Maximum Units

This policy defines Humana's reimbursement rules for time-based service codes billed for Kentucky Medicaid members. It establishes that billed units for these codes must not exceed the least restrictive limit when comparing: (1) applicable CMS guidance, (2) Kentucky Department for Medicaid Services (KDMS) guidance, (3) Humana guidance (including the Humana Healthy Horizons in Kentucky Policies Booklet), and (4) the per-date-of-service 24-hour maximum. Code-specific groups, edits, and precise unit limits are maintained in the external CMS, KDMS, and Humana resources referenced in the policy and should be consulted for exact billing and edit guidance.

Unit limits (thresholds)

Maximum units per date of serviceNo more than the number of units that equal a single 24-hour period (per date of service)

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

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

Comparator — Humana guidanceApply any limitation outlined in applicable Humana policy or guidance, including Humana Healthy Horizons in Kentucky Policies Booklet

Definition: Time-based service codes are codes used to document and bill for services that are measured and reimbursed according to the amount of time spent delivering the service (for example, prolonged services and certain evaluation and management, therapy, and care management services).

What Providers Must Do

Billing Rule

Determine allowable units for time-based codes

When billing time-based service codes for Humana Kentucky Medicaid members, submit units no greater than the least restrictive limit among (1) applicable CMS guidance, (2) KDMS guidance, (3) Humana guidance (including Humana Healthy Horizons in Kentucky Policies Booklet), and (4) the per-date-of-service 24-hour maximum.

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, the maximum number of units that equals a single 24-hour period

Documentation Required

Follow plan requirements and medical necessity

Claims remain subject to other plan requirements such as medical necessity, reasonableness, and applicable referral or authorization requirements. Maintain documentation to support billed time and medical necessity per those requirements.

Billing Rule

Reference external sources for specific limitations

For specific unit limitations and edits, providers should reference external sources listed in the policy, including CMS Medicaid NCCI Edit Files, KDMS policies and fee schedules, and Humana Healthy Horizons in Kentucky resources found in the References section.

OpenPayer

Time-Based Service Codes

Unit Allowance Decision Rule

Time-Based Codes & Maximum Units

What Providers Must Do

External Resources

Policy Background