Humana
Outpatient Physical, Occupational, and Speech Therapy Management Program

Humana has delegated Medical Management responsibilities for physical, occupational and speech therapy services to OrthoNet for HMO, POS, EPO, PPO and Medicare Advantage members. OrthoNet’s scope of responsibility includes the management of the prior-authorization process for outpatient therapy services.

Pain Management, Musculoskeletal Surgery Programs

Humana has delegated the precertification of spinal and certain musculoskeletal surgeries in any setting as well as outpatient interventional pain management procedures (not including trigger point injections) to OrthoNet. These procedures and their CPT codes are listed on the applicable Humana Prior Authorization List which can be viewed at Humana's website (humana.com).

Services for members covered by Humana’s commercial programs (HMO, POS, PPO, EPO) and Medicare Advantage Programs (not including Private Fee-for-Service members) on these lists must be pre-certified through OrthoNet. Humana will continue to provide all other related services for these procedures such as claim payment, patient case management, member services and provider relations services.

See Frequently Asked Questions (PT/OT/ST)

See Frequently Asked Questions (Pain Management and Musculoskeletal Surgery)

Quick Reference PT/OT/ST Therapy Program for Humana Members

Forms

Instructions

Click the link to open the form in a new browser window, then use your browser's Print button to print it. To download the form for later printing, right-click the link and choose "Save target as..." from the popup menu. Then use the file dialog to navigate to a folder on your hard drive where you wish to save the file.

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Therapy Request Form Dysphagia Evaluation  
PT/OT Initial Evaluation Report Pain Management Therapy Request Form  
PT/OT Initial Evaluation Report For Vestibular Dysfunction Speech Language Pathology Form  
Functional Progress Chart Speech Evaluation Form  
Videofluoroscopic Examination Of Swallowing TX Prior Authorization Form (optional)  
Musculoskeletal Surgery Request Form IN Prior Authorization Form (optional)  

Prior Authorization Submission
and
Status

To begin using our secure site; you must create a user account.
  • New User-Account Request Form

  • To submit authorization check status
  • Request Authorization or Check Status

  • Click on the Web Portal User Guide for step by steps instructions.

    Contact

    Outpatient Therapy
    800-862-4006
    Fax: 800-863-4061

    Pain Management
    888-605-5344
    Fax: 888-605-5345

    Musculoskeletal Surgery
    866-565-4733
    Fax: 866-621-9008

    Health Plan Web Site

    www.humana.com