Medicare AdvantageAdministrativeLow impact
Psychiatric Partial Hospital Program Services - Medicare Advantage (Revised)
Humana·IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH, AL, GA, TN, NC, SC, VA, WV · Psychiatry·Medicare Advantage
Effective date
Sep 1, 2026
We identified it
Sep 2, 2026
Summary
This is a routine annual review of Humana's Medicare Advantage psychiatric partial hospital program (PHP) coverage policy with no coverage changes. The policy remains effective 09/01/2026 and continues to require medical necessity based on LCD L37633 criteria, with PHP services requiring a minimum of 20 hours per week of therapeutic care. Billing teams should verify their current processes align with the standard revenue codes (0900, 0904, 0910, 0912, 0913, 0914, 0915, 0916, 0918, 0942) and applicable MACs for their geographic jurisdiction.
Action Required
By 09/01/2026: Ensure billing software and staff are aligned with the current policy requirements. Verify that PHP claims are submitted using the correct revenue codes (0900, 0904, 0910, 0912, 0913, 0914, 0915, 0916, 0918, 0942) for the applicable MAC jurisdiction. Confirm that prior authorization requests include documentation of medical necessity referencing LCD L37633 criteria and minimum 20 hours per week therapeutic services requirement. For jurisdictions with LCDs (J6, JK, J15, JJ, JM), apply the applicable LCD; for jurisdictions without LCDs (J5/J8, JE/JF, JH/JL, JN), use LCD L37633 criteria. No immediate action required as this is a no-change annual review, but maintain current compliance practices.