Prior Authorization
Humana Prior Authorization for CPT 93656
Cardiovascular procedures · Standard commercial plans
Source
Humana Commercial Preauthorization and Notification List (July 2024)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.
Clinical criteria
Humana requires prior authorization for AF ablation (93656). Symptomatic paroxysmal or persistent AF refractory to at least one Class I or III antiarrhythmic drug, or documented intolerance. Must submit EKG documenting AF, echocardiogram within past year, drug trial documentation, and TEE if AF >48 hours.
Documentation checklist
- ✓12-lead EKG or rhythm strip documenting atrial fibrillation
- ✓Echocardiogram within 12 months
- ✓Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome
- ✓TEE or cardiac CT results for LAA assessment
Submission channels
Phone
1-800-444-9137Fax
1-877-418-05062026 Medicare rate for CPT 93656
Office (non-facility)
$806.63
Facility
$806.63
Total RVUs (office)
24.15
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 93656 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: 12-lead EKG or rhythm strip documenting atrial fibrillation, Echocardiogram within 12 months, Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome….
- 3Submit via phone or fax, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 93656?
- Yes. Humana requires prior authorization for CPT 93656 (Cardiovascular procedures) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 93656?
- 12-lead EKG or rhythm strip documenting atrial fibrillation; Echocardiogram within 12 months; Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome; TEE or cardiac CT results for LAA assessment
- How much does Medicare pay for CPT 93656 in 2026?
- In 2026, the national Medicare allowable for CPT 93656 is $806.63 in an office setting and $806.63 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 93656?
- 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
CPT 93656 prior authorization by payer
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