Negative pressure wound therapy

Preauthorization of negative pressure wound therapy (NPWT) is required for commercial (including members with Humana individual products), Medicaid and Medicare Advantage (MA) health maintenance organization (HMO) and preferred provider organization (PPO) members.

The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process. For MA private fee-for-service (PFFS) plans, notification is requested, not required.

Humana does not review preauthorization requests for the following, as health care providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:

  • Members treated by Chicago risk and delegated providers.
  • Florida Medicare Advantage (MA) health maintenance organization (HMO) and Medicaid HMO members.
  • Health Care Partners commercial and MA HMO members

Please note:

  • For Puerto Rico commercial members, submit preauthorization requests by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico MA members, submit preauthorization requests by telephone at 1-866-488-5995 or 1-866-773-5959, or by fax to 1-800-594-5309.
  • For MA Private Fee-for-Service (PFFS) members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
  • Preauthorization is not required for services provided by nonparticipating health care providers for MA PPO members. Notification is requested, but not required, as this helps coordinate care for our members.

Submitting preauthorization requests

Initial therapy: If you want to preauthorize initial NPWT, please complete this form.

Initiation of NPWT form (215 KB)

Continuing therapy: If you want to request continued coverage of NPWT, please complete our preauthorization form.

NPWT reauthorization form (166 KB)

Instructions for submitting the initiation and reauthorization forms are found on the last page of each form.

Texas preauthorization request form (145 KB)

Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are available here. Once complete, please fax it to Humana at 1-800-266-3022. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana preauthorization request form (761 KB)

Physicians and other clinicians in Indiana may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax it to Humana at 1-800-266-3022. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Questions

Questions about the preauthorization or reauthorization of NPWT may be directed to Humana’s clinical intake team at 1-800-523-0023. Representatives are available Monday through Friday from 8 a.m. to 8 p.m. Eastern time.