Out Patient

Outpatient therapy

Occupational, physical and speech therapy

Preauthorization for outpatient therapy services is administered by OrthoNet, a musculoskeletal disease management company that provides a broad range of orthopedic administrative and medical management services. OrthoNet is Humana’s network manager for designated outpatient occupational, physical and speech therapy services and conducts peer-to-peer reviews of physicians’ preauthorization requests.

Preauthorization and notification requirements

The terms prior authorization, precertification, preadmission, preauthorization and notification all are used to refer to the preauthorization process. Humana requires preauthorization for outpatient therapy services for most commercial and Medicare Advantage (MA) members. Preauthorization requirements for administrative-services-only groups and Medicaid members vary; please call Humana at the number on the back of the member’s identification card to determine whether preauthorization is required.

For Medicare Advantage (MA) private fee-for-service (PFFS) plans, notification is requested, but it is not required.

Exclusions from the preauthorization requirement include the following members and health care providers*:

  • Members with Humana individual products
  • Commercial and MA health maintenance organization (HMO) members assigned to a risk-based or delegated independent physician association (IPA) or physician hospital organization (PHO)
  • MA HMO members in Alabama, California, Florida, Georgia, Louisiana, Mississippi, Nevada, North Carolina, South Carolina and Tennessee
  • Puerto Rico members

*This is not an all-inclusive list.

Submitting preauthorization requests

Humana requires that occupational, physical and speech therapy treatment plans ordered for a Humana-insured patient be faxed to OrthoNet at 1-800-863-4061. MA PFFS notifications also should be submitted in this manner.

Additional resources

Humana/OrthoNet therapy program for Humana members and related forms

Learn more about this program and the patient information required when requesting preauthorization or providing notification. This link also provides access to therapy request forms, evaluation forms and other OrthoNet documents.


Questions about this program may be directed to OrthoNet’s provider services department at 1-800-862-4006. Representatives are available to assist callers between 8 a.m. and 8 p.m. Eastern time, Monday through Friday.