|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