Humana
Outpatient Physical, Occupational, and Speech Therapy Management Program

IMPORTANT NOTICE: As of January 1, 2018, Humana no longer requires preauthorization for outpatient physical, speech and occupational therapy (PT/ST/OT) services. Due to Humana's system enhancement schedule, Humana removed preauthorization requirements for PT/ST/OT services as of Dec. 18, 2017. Please note, even though these services no longer require preauthorization, plan visit limits and dollar-limit maximums still apply. Other plan provisions, such as referral requirements, also still apply. Humana reserves the right to review these services retrospectively to ensure services are medically necessary. For more information, contact Humana using the telephone number listed on your patient's Humana ID card.

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 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 (Pain Management and Musculoskeletal Surgery)

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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Pain Management Therapy Request Form  
Musculoskeletal Surgery Request Form  
TX Prior Authorization Form (optional)  
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

    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