Authorizations and referrals

This page can help you determine which services need preauthorization and how to submit preauthorization and referral requests.

Preauthorization and notification lists

View documents that list services and medications for which preauthorization may be required for patients with Humana Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.

Online referrals and preauthorization requests

Learn how to submit requests on and

State-specific preauthorization forms

Find forms that may be used by physicians and other health care practitioners to submit preauthorization requests in specific states.

Additional resources

The links below offer details on how to request preauthorization and submit notification for various tests and procedures.


Preauthorization requests for knee, shoulder and hip arthroscopies are reviewed by OrthoNet.

Behavioral health services

Preauthorization requests for mental health and substance use services for patients with Humana commercial and Medicare Advantage (MA) coverage are managed by Humana Behavioral Health, a wholly owned Humana subsidiary.

Cardiac devices 

Preauthorization determinations for cardiac implantable devices (e.g., pacemakers, leadless pacemakers, left atrial appendage closure devices, defibrillators, cardiac resynchronization therapy devices) and ventricular assist devices (VAD); external wearable devices (e.g., defibrillators LifeVest®); and cardiac loop recorders (internal/external) are reviewed by HealthHelp.

Chemotherapy Agents, Supportive Drugs and Symptom Management Drugs

Preauthorization is required for chemotherapy agents, supportive drugs and symptom management drugs.

Diagnostic and interventional cardiology

Preauthorization requests for diagnostic cardiology, catheterization and interventional cardiology are reviewed by HealthHelp®.

Diagnostic imaging

Preauthorization requests for diagnostic imaging are reviewed by HealthHelp.

Facility-based sleep studies (PSG)

Preauthorization requests for facility-based sleep studies, also known as polysomnography (PSG), are reviewed by HealthHelp®.

Foot surgeries

Preauthorization requests for bunionectomies and hammertoe surgeries are reviewed by OrthoNet.

Molecular diagnostic/genetic testing

Preauthorization is required for services related to molecular diagnostic/genetic testing (MD/GT).

Negative pressure wound therapy (NPWT) 

Preauthorization may be required for initial and continued NPWT services. Forms for initiation and reauthorization of NPWT are available.

Oncology surgery and biopsy services 

Preauthorization requests for oncology surgery (breast lumpectomy, simple mastectomy and gynecomastia surgery) and biopsy services (excisional biopsy for breast cancer and thoracotomy/thoracoscopy for lung cancer) are reviewed by HealthHelp®.

Outpatient echocardiography and percutaneous coronary intervention (coronary angioplasty/stent)

Preauthorization requests for outpatient echocardiography and percutaneous coronary intervention (coronary angioplasty and stent) are reviewed by HealthHelp®.

Outpatient therapy

Effective Dec. 18, 2017, Humana will no longer require PT/OT/ST preauthorization for patients with Humana MA and commercial coverage.

Pain management

Preauthorization requests for pain management services are reviewed by OrthoNet.

Radiation therapy

Preauthorization requests for radiation therapy are reviewed by HealthHelp®.

Medical and pharmacy coverage policies

Learn more about Humana's Medical and Pharmacy Coverage Policies

Medical and Pharmacy Coverage Policies (opens in new window) 

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