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

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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  

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