Humana Coverage Criteria
Latest Humana coverage criteria updates4
- Coverage CriteriaReimbursement/Payment PolicyEff. 2023-07-01Laboratory General Inflammation Testing (CRP and ESR)Defines Humana Medicare Advantage payment and reimbursement criteria for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) laboratory testing, including allowed frequencies and clinical indications for reimbursement.All Humana updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2023-07-01Laboratory Urine Culture Testing for BacteriaHumana Medicare Advantage payment policy describing reimbursement and coverage criteria for urine culture and related microbiology procedures for Humana members under Medicare Advantage plans.All Humana updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-06-01Laboratory — Lyme Disease Testing Coverage CriteriaHumana payment policy for laboratory testing related to Lyme disease for Medicare Advantage and Commercial products, describing which serologic and molecular tests are reimbursable or not and referencing applicable Medicare LCD/NCD guidance.All Humana updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2018-04-01Emergency Department E/M ReimbursementDefines Humana's criteria for facility-level emergency department evaluation and management (E/M) service reimbursement for Medicare Advantage, Kentucky Medicaid and Oklahoma Medicaid products, describing which CPT and HCPCS codes correspond to each ED visit level and the minimum clinical criteria used to determine appropriate payment level.All Humana updates
Tool Description
Search Humana coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
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Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
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