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.

Spinal Surgery and Pain Management Programs

Humana has delegated the precertification of spine surgery in any setting as well as pain management procedures (not including trigger point injections) in all settings 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 Spinal 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 harddrive where you wish to save the file.

Get Adobe ReaderAll forms are PDF files. You'll need Adobe® Reader® to view and print them. Adobe Reader is available from Adobe for free.

Therapy Request Form Dysphagia Evaluation  
PT/OT Initial Evaluation Report Speech Language Pathology Evaluation - Adult  
PT/OT Initial Evaluation Report For Vestibular Dysfunction Speech Language Pathology Evaluation - Pediatric  
Functional Progress Chart Speech Language Pathology Clinical Update  
Videofluoroscopic Examination Of Swallowing Pain Management Therapy Request Form  

Contact

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

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

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

Health Plan Web Site

www.humana.com