Humana Bundled CPT codes list

Humana utilizes the following code-editing logic:

• CPT 78593 will not be separately reimbursed when submitted with CPT 78585.

• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.

• CPT 20936 will not be separately reimbursed when submitted with CPT 22630.

• CPT 29877 will not be separately reimbursed when submitted with CPT 29881.

• CPT 36410 will not be separately reimbursed when submitted with CPT 80053.

• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:

80048, 82248, 82948, 84132, 84520, 86141, 80050, 82306, 82950, 84144, 84550, 86304, 80051, 82310, 82951, 84146, 84702, 86308, 80053, 82378, 82962, 84153, 84703, 86318, 80055, 82465, 82977, 84155, 85007, 86376, 80061, 82533, 83001, 84402, 85013, 86592, 80069, 82550, 83036, 84403, 85014, 86677, 80074, 82565, 83090, 84432, 85018, 86701, 80076, 82575, 83516, 84436, 85025, 86703, 80162, 82607, 83540, 84439, 85027, 86762, 80164, 82627, 83615, 84443, 85060, 86850, 80178, 82670, 83655, 84450, 85610, 86900, 80185, 82728, 83718, 84460, 85651, 87340, 82040, 82746, 83721, 84478, 85652, 87430, 82105, 82784, 83735, 84479, 85730, 82140, 82785, 83880, 84480, 86038, 82150, 82947, 84100, 84481, 86140,

• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:

80061, 82947, 83036, 85013, 85025, 85610, 82247, 82948, 83655, 85014, 85027, S3620, 82465, 82962, 85007, 85018, 85048

• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:

80053, 85025

• CPT 36600 will not be separately reimbursed when submitted with CPT 82803.

• CPT 51797 will not be separately reimbursed when submitted with CPT 51795.

• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:

99283, 99284, 99285

• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:

99283, 99284, 99285

• CPT 72020 will not be separately reimbursed when submitted with CPT 72100.

• CPT 72100 will not be separately reimbursed when submitted with CPT 72148.

• CPT 73600 will not be separately reimbursed when submitted with CPT 99283.

• CPT 73610 will not be separately reimbursed when submitted with CPT 99283.

• CPT 73620 will not be separately reimbursed when submitted with CPT 99283.

• CPT 74020 will not be separately reimbursed when submitted with CPT 99285.

• CPT 74022 will not be separately reimbursed when submitted with the following CPT codes:

99284, 99285

• CPT 78890 will not be separately reimbursed when submitted with CPT 93015.

• CPT 92568 will not be separately reimbursed when submitted with CPT 92569.

• CPT 92950 will not be separately reimbursed when submitted with CPT 99291.

• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:

99213, 99223, 99233, 99254, 99291, 99214, 99232, 99244, 99255

• CPT 93041 will not be separately reimbursed when submitted with the following CPT codes:

A0426
A0427

• CPT 93042 will not be separately reimbursed when submitted with the following CPT codes:

99231, 99232, 99233, 99254, 99255

• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:

95115, 95117, 99213, 99214

• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:

36415, 93005, 99202, 99213, 99245, 64483, 93010, 99203, 99214, 99283, 80053, 94010, 99204, 99215, 99284, 85025, 94640, 99205, 99243, 99285, 93000, 99058, 99212, 99244, A0427

• CPT 94761 will not be separately reimbursed when submitted with the following CPT codes:

99213, 99214, 99284, 99285

• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:

99391, 99392

• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:

11100, 80055, 82947, 85025, 99213, 99394, 17000, 80061, 82948, 85610, 99214, 99395, 36410, 80076, 82950, 88142, 99215, 99396, 36415, 81000, 82962, 99202, 99244, 99397, 57454, 81002, 83036, 99203, 99385, 58100, 81003, 84439, 99204, 99386, 80048, 82105, 84443, 99205, 99391, 80050, 82270, 85007, 99211, 99392, 80053, 82465, 85018, 99212, 99393

• CPT 99001 will not be separately reimbursed when submitted with the following CPT codes:

80048, 80053, 85025

• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:

99213, 99383, 99393, 99395, 99214, 99392, 99394

• CPT A4208 will not be separately reimbursed when submitted with the following CPT codes:

99213, 99214

• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:

99211, 99213, 99214

• CPT A4550 will not be separately reimbursed when submitted with the following CPT codes:

99213, 99214

• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:

99385, 99387, 99396, G0101, 99386, 99395, 99397

• CPT 76645 will not be separately reimbursed when submitted with CPT 76942.

• CPT 76830 will not be separately reimbursed when submitted with CPT 76856.

• CPT 80076 will not be separately reimbursed when submitted with CPT 80053.

• CPT 82803 will not be separately reimbursed when submitted with CPT 99285.

• CPT 94260 will not be separately reimbursed when submitted with the following CPT codes:

94240, 94761

• CPT 94640 will not be separately reimbursed when submitted with the following CPT codes:

94060, 99285

• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:

99213, 99214, 99215, 99244

• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:

97110
97140

• CPT 97004 will not be separately reimbursed when submitted with CPT 97110.

• CPT 97140 will not be separately reimbursed when submitted with CPT 98943.

• CPT 99070 will not be separately reimbursed when submitted with the following CPT codes:

A4550, J1100, J7050

• CPT 99215 will not be separately reimbursed when submitted with CPT 99396.

List of Medical Specialties

No.	Specialty	Specialists Focus
1	Allergy & Immunology	Allergic and immunologic diseases and their respiratory complications (such as pollen, chemical and food allergies, asthma and AIDS).
2	Anesthesia	Anesthesia or relief of pain during surgery and childbirth, and control of paid due to various causes.
3	Cardiovascular Disease (Cardiology)	Diseases of the heart and blood vessels.
4	Dermatology	Diseases of the skin.
5	Emergency Medicine	Diseases that are acute medical or surgical conditions or injuries that require urgent or immediate care (usually in a hospital emergency room).
6	Endocrinology and Metabolism	Diseases of the internal glands of the body, including diabetes mellitus.
7	Family Practice	All diseases and related total health care of an individual and the family.
8	Gastroenterology	Diseases of the digestive tract, including the stomach, bowel, liver and pancreas.
9	General Practice	All diseases and related total health care of an individual and the family.
10	Geriatric Medicine	Diseases of the elderly.
11	Gynecology	See "Obstetrics and Gynecology".
12	Gynecologic Oncology	Cancer diseases of the female reproductive system.
13	Hematology	Disorders of the blood and blood-forming organs (including cancerous disorders of the blood) such as anemia, leukemia and lymphoma (see Oncology, Medical).
14	Infectious Diseases	Infections of all types.
15	Internal Medicine	All diseases and total health care of adults, usually 18 years of age and older.
16	Neonatology	Disease of the newborn child.
17	Nephrology	Diseases of the kidney, including dialysis.
18	Neurology	Diseases of the brain, spinal cord, nervous system and related structures.
19	Neurological Surgery	Diseases of the brain, spinal cord, nervous system and related structures requiring surgery.
20	Obstetrics and Gynecology	Normal and abnormal pregnancy, diseases of the female reproductive system and fertility disorders.
21	Oncology, Medical	Cancer and disorders of the blood and blood-forming organs (see Hematology).
22	Ophthalmology	Diseases of the eye.
23	Orthopedic Surgery	Diseases of the bones, joints, muscles and tendons.
24	Otorhinolaryngology (Ear, Nose & Throat)	Diseases of the ears, nose, sinuses, throat and upper airway passages.
25	Pathology	Tissues and specimens removed by biopsy and surgery to diagnose normal from diseased tissues and specimens; supervises and interprets laboratory tests on blood, urine and other body fluids.
26	Pediatrics	All diseases and total health care of newborns, infants, children and adolescents.
27	Physical Medicine and Rehabilitation	Diseases with major and minor disabilities requiring restoration of functional ability such as assistance, retraining and recondition of muscles, tendons and extremities for ambulation and other activities of daily living.
28	Plastic Surgery	Diseases and conditions requiring surgical reconstruction for deformity or loss of a body part, or for cosmetic purposes to improve appearance or function.
29	Podiatric Medicine (Podiatry)	Disease of the foot and ankle as they affect the conditions of the feet.
30	Preventative Medicine	Health care and other measures to avoid delay or prevent disease or illness from occurring.
31	Psychiatry	Diseases affecting mental health including diseases of the brain, nervous system and substance abuse of drugs or chemicals.
32	Pulmonary Disease	Diseases of the lung.
33	Radiology, Diagnostic	X-ray, ultrasound and other imaging techniques such as Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI).
34	Radiology, Nuclear	Diseases requiring use of radioactive isotopes or as an aid in diagnosis and/or therapy.
35	Radiation Oncology	Cancer and other diseases with x-ray therapy, radioactive isotopes and linear accelerator particle radiation.
36	Rheumatology	Diseases of the joints including arthritis and autoimmune diseases.
37	Sports Medicine	Diseases and injuries acquired in sports.
38	Surgery, General	Disease that require surgical operation for diagnosis or treatment.
39	Surgery, Hand	Diseases and injuries of the nerves, tendons, muscles, bones or skin of the hand requiring surgery.
40	Surgery, Thoracic	Diseases of the chest, including lungs, heart, blood vessels and chest wall, that require surgical operation for diagnosis and/or treatment.
41	Surgery, Vascular	Diseases of the blood vessels that require surgical operation for diagnosis or treatment.
42	Surgery, Colon and Rectal	Diseases of the large intestine (bowel), rectum and anus that require surgical operation for diagnosis or treatment.
43	Surgery, Urology	Diseases of the kidneys, bladder and male reproductive tract that require surgical operation.

ANSI 5010 Claim Format

ANSI 5010 is the newest standard adopted to transmit medical information securely and with as much detail as possible.

Reading this information was never truly meant for human eyes to process, but for quick information it is good to know the basics and you can generally pick out what you are looking for and what you are looking at.

Here is an example claim with two transactions (1 transaction containing an NDC) for one payer/carrier for one patient sent in ANSI 5010 837P format :

(Below the example I will break down what this information is and how it relates to the claim)

((Also note that this information is purely fictional and is pulled from Medisoft's Tutorial Data, any relationship or similarities to actual persons are completely coincidental and unintended))

ISA*00*          *00*          *ZZ*SENDERIDISA06*ZZ*RECEIVERIDISA08*120219*0910*|*00501*000000001*1*P*:

GS*HC*SENDERCODE*RECEIVERCODE*20120219*0910*1*X*005010X222A1

ST*837*0001*005010X222A1

BHT*0019*00*11AAAA*20120219*0910*CH

NM1*41*2*PRACTICE NAME*****46*SENDERID

PER*IC*FIRST LAST*TE*8003334747

NM1*40*2*CCB MEDICAID*****46*RECEIVERID

HL*1*1*20*1

NM1*85*2*HAPPY VALLEY MEDICAL CLINIC*****XX*1234567891

N3*5222 E. BASELINE RD.

N4*GILBERT*AZ*85234

REF*EI*123456789

NM1*87*2

N3*1944 N. KLUGE DR.*SUITE 8381

N4*GILBERT*AZ*85234

HL*1*1*22*1

SBR*P*18*25BB******CH

NM1*IL*1*YOUNGBLOOD*MICHAEL*C***MI*USAA236678

N3*73982 N. 28TH AVE.

N4*PHOENIX*AZ*85044

DMG*D8*19620705*M

NM1*PR*2*U.S. TRICARE*****PI

CLM*17*5007.5***11:B:1*Y*A*Y*Y**OA:EM

DTP*439*D8*20100101

HI*BK:8472*BF:73730*BF:3469

NM1*82*1*HINCKLE*WALLACE****XX*9876543210

PRV*PE*PXC*PROVITAXON

LX*1

SV1*HC:99000:::::HANDLING FEE*8*UN*1***1:2:3

DTP*472*D8*20120219

REF*6R*100

LX*1

SV1*HC:J0490:::::BENADRYL HCL, UP TO 50 MG.*4999.5*UN*1***1:2:3

DTP*472*D8*20120219

REF*6R*99

LIN**N4*12345678901

CTP****50*UN

SE*9999*0001

GE*9999*1

IEA*9999*000000001

FILE HEADER INFORMATION-
This information is normally defined at the clearing house or carrier direct where you are sending the claim file.  Checking for an EDI Companion guide would detail what information needs to be sent here; normally the entire file will be rejected if this information is incorrect.  (In Revenue Manager this information is defined under Configure->Receivers->Header Information &Transaction Set drop-downs)

ISA*00*          *00*          *ZZ*SENDERIDISA06*ZZ*RECEIVERIDISA08*120219*0837*|*00501*000000001*1*P*:	ISA Loop
GS*HC*SENDERCODE*RECEIVERCODE*20120219*0837*1*X*005010X222A1	GS Loop
ST*837*0001*005010X222A1	ST Loop
BHT*0019*00*11AAAA*20120219*0837*CH	ST Loop

Submitter Name & Contact Information

This information will be dependent on the clearing house or carrier direct's requirements; but will normally be the userID or Submitter Number, the contact information is required to be sent, but I have yet to meet someone that has been contacted via this information.  (In Revenue Manger this information is defined under Configure->Receivers->Header Information)

NM1*41*2*PRACTICE NAME*****46*SENDERID	1000A Loop
PER*IC*FIRST LAST*TE*8003334747	1000A Loop

Receiver Name

This information will be the clearing house or carrier direct where you are sending the claim file.  This information will be in the EDI Companion guide normally. (In Revenue Manger this information is defined under Configure->Receivers->Header Information)

NM1*40*2*CCB MEDICAID*****46*RECEIVERID	1000B Loop
HL*1*1*20*1	2000A Loop

Billing Provider's Name & Contact Information

This information will be defined and pulled from Medisoft's Practice information if the rendering provider is set to file claim as group.  Otherwise the individual provider's information would replace the information seen here.  This would relate to the information in Box 33 on a HCFA Paper claim.

NM1*85*2*HAPPY VALLEY MEDICAL CLINIC*****XX*1234567891	2010AA Loop-NM1 Seg
N3*5222 E. BASELINE RD.	2010AA Loop-N3 Seg
N4*GILBERT*AZ*85234	2010AA Loop-N4 Seg
REF*EI*123456789	2010AA Loop-REF Seg

Billing Provider's Pay-To Address Information

This information will be defined and pulled from Medisoft's Practice Information's Pay-To tab.  Because of new requirements with ANSI 5010, a physical address must be sent for the Billing Provider in loop 2010AA and then an additional address can be added such as a PO Box or another separate payment address can in loop 2010AB, if you would prefer not to have payments sent to the Billing Provider's physical address.  Normally the payment address must be on file with both the carriers and the clearing house where you are sending the claim.

NM1*87*2	2010AB Loop-NM1 Seg
N3*1944 N. KLUGE DR.*SUITE 8381	2010AB Loop-N3 Seg
N4*GILBERT*AZ*85234	2010AB Loop-N4 Seg
HL*1*1*22*1	2000B Loop
SBR*P*18*25BB******CH	2000B Loop

Patient and Contact Information

This information will be pulled from the patient's information in Medisoft.  This loop will repeat until all the patients and their claims and transactions have been processed.

NM1*IL*1*YOUNGBLOOD*MICHAEL*C***MI*USAA236678	2010BA Loop-NM1 Seg
N3*73982 N. 28TH AVE.	2010BA Loop-N3 Seg
N4*PHOENIX*AZ*85044	2010BA Loop-N4 Seg
DMG*D8*19620705*M	2010BA Loop-DMG Seg

Claim's Carrier/Payer

This will be the claim's current payer. (ex if the claim has Medicare as primary insurance and BCBS for secondary insurance; if this was the primary claim, this would show Medicare's information, otherwise for secondary claims this would show BCBS' information.)

NM1*PR*2*U.S. TRICARE*****PI

2010BB Loop-NM1 Seg

Beginning of Claim

This is the beginning of the claim for this patient.  Claims will have a transaction limit of 6, so after 6 transactions have been processed a new claim loop of 2300 will repeat if there are more pending transactions for this patient.

CLM*17*5007.5***11:B:1*Y*A*Y*Y**OA:EM	2300 Loop-CLM Seg
DTP*439*D8*20100101	2300 Loop-DTP Seg
HI*BK:8472*BF:73730*BF:3469	2300 Loop-HI Seg

Rendering Provider's Information

This information will be pulled from the Assigned Provider of the claim. (Note: this does not mean the transaction line's assigned provider necessarily; this will depend on how you "Create Claims" in Medisoft; Assigned Provider radio will pull from the Assigned Provider of that Case, where Attending Provider will group and create claims based on the Assigned Provider at the Transaction line.)  This loop will be omitted if the Billing Provider is the Rendering Provider (ex. Provider is filing claim as Individual).  (Note: This NPI would relate to box 24j on a Paper HCFA claim.)

NM1*82*1*HINCKLE*WALLACE****XX*9876543210	2310B Loop-NM1 Seg
PRV*PE*PXC*PROVITAXON	2310B Loop-PRV Seg

First Transaction on Claim

This is the first transaction's information broken down.

LX*1	2400 Loop-LX Seg
SV1*HC:99000:::::HANDLING FEE*8*UN*1***1:2:3	2400 Loop-SV1 Seg
DTP*472*D8*20120219	2400 Loop-DTP Seg
REF*6R*100	2400 Loop-REF Seg

Second Transaction on Claim

The transaction loop will repeat until all the transaction lines on the claim have been processed.

LX*1	2400 Loop-LX Seg
SV1*HC:J0490:::::BENADRYL HCL, UP TO 50 MG.*4999.5*UN*1***1:2:3	2400 Loop-SV1 Seg
DTP*472*D8*20120219	2400 Loop-DTP Seg
REF*6R*99	2400 Loop-REF Seg

NDC Information for Second Transaction on Claim

Additional information, such as the NDC information, will sometimes be added between the transaction entries and will apply to the transaction directly above it.

LIN**N4*12345678901	2410 Loop-LIN Seg
CTP****50*UN	2410 Loop-CTP Seg

File Footer Information

Once all the transactions, claims, and patients have been processed, this information will be added to signify the end of the claim file.

SE*9999*0001	SE Loop
GE*9999*1	GE Loop
IEA*9999*000000001	IEA Loop