Medicare AdvantageCoverageMedium impact
Quantity Limitation (Revised)
Humana·KY, SC, OH, IN, OK, VA·Medicaid
We identified it
Jul 2, 2026
Summary
This is a revised Quantity Limitation guidance policy from Humana affecting Medicare and Medicaid members across multiple states (Kentucky, South Carolina, Ohio, Indiana, Oklahoma, Virginia). The policy establishes or updates quantity limits on covered services. However, specific details about which services are limited, what the new limits are, and how they differ from previous guidance cannot be determined from the summary-only content provided.
Action Required
URGENT: Billing team must obtain the full policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5ac) immediately. The summary-only version does not contain specific billing codes, effective dates, or quantity limit thresholds needed for implementation. Once full policy is retrieved: (1) Identify all affected CPT/HCPCS codes and their new quantity limits; (2) Determine effective date and implementation deadline; (3) Update billing software to enforce quantity limits and flag claims exceeding limits; (4) Alert providers in affected states (KY, SC, OH, IN, OK, VA) of new restrictions; (5) Establish process for prior authorization requests when quantity limits are exceeded. Without the complete policy details, claims may be incorrectly billed and denied.