Does Humana require prior authorization for CPT 93260?

Status not confirmed in our dataset. Confirm against the current Humana clinical policy before submitting.

What documentation does Humana require for CPT 93260?

Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.

How much does Medicare pay for CPT 93260 in 2026?

In 2026, the national Medicare allowable for CPT 93260 is $75.49 in an office setting and $75.49 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.

What if Humana denies the PA for CPT 93260?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Humana Prior Authorization for CPT 93260

Programming evaluation of implantable subcutaneous cardiac defibrillator · Standard commercial plans

Status not confirmed

Source

Data pending source-document linkage. Verify against Humana's current clinical policy before submission.

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

We don't have a source-backed prior-authorization verdict for CPT 93260 with Humana under Standard commercial plans yet — confirm directly with the payer. The 2026 Medicare reference rate for this code is below, and you can draft the request free in Ask D3.

2026 Medicare rate for CPT 93260

Office (non-facility)

$75.49

Facility

$75.49

Total RVUs (office)

2.26

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 93260 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather patient history, prior conservative treatment, and clinical justification.
3Submit via the payer's provider portal or designated PA channel.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Humana require prior authorization for CPT 93260?: Status not confirmed in our dataset. Confirm against the current Humana clinical policy before submitting.
What documentation does Humana require for CPT 93260?: Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.
How much does Medicare pay for CPT 93260 in 2026?: In 2026, the national Medicare allowable for CPT 93260 is $75.49 in an office setting and $75.49 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
What if Humana denies the PA for CPT 93260?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Humana PA lookups

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All Humana prior-authorization requirements →

CPT 93260 prior authorization by payer

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