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Kentucky Medicaid

Payment Policies

Payment policies are designed to assist you when submitting claims to Humana – CareSource®. They are routinely updated to promote accurate coding and policy clarification. These proprietary policies are not a guarantee of payment. Payments for claims may be subject to limitations and/or qualifications. Payment will be determined based upon a review of the actual services provided to a member and will be determined when the claim is received for processing. Health care providers and their office staff are encouraged to use self-service channels to verify member’s eligibility.

The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.

Current Payment Policies

PolicyEffective Date
Acupuncture Services
Advanced Diagnostic Imaging Services
Allergy Testing and Allergen Immunotherapy
Antigen Leukocyte Cellular Antibody Testing ("ALCAT")
Bilateral Procedures
Blood Specimen Collection Fee (Venipuncture)
Chiropractic Care
Corneal Tissue Replacement at Free-standing Surgical Centers
CPT Codes Not Covered in an Emergency Room Setting
Drug Screening Tests
Dry Eye Syndrome Testing
Durable Medical Equipment and Modifiers
Emergency Department EKG and Imaging Interpretation
Family Planning
Free Standing Ambulatory Surgical Centers Claims for CPT Code 41899
Healthcare Acquired Conditions, Provider Preventable Conditions and Conditions Present on Admission
Mammography Services
Medication Assisted Therapy
Occupational, Physical, & Speech Therapy
Out-of-Network Providers Policy for Medically Necessary Services
Oxygen Delivery Systems & Supplies
Pass-Through Billing
Post Stabilization Care Services
Preventive Services and Sick Visit on Same Date of Service
Provider Issue Resolution Process
Psychiatric Day Programs
Sexually Transmitted Infections (“STI”) Screening
Transcutaneous Electrical Nerve Stimulators (“TENS”)
Vaccine (Immunization) Services

Archived Payment Policies