|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.
Please visit https://www.humana.com/provider/support/whats-new for more information or 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)
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