Negative pressure wound therapy

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

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. Notification is requested for these plans so we may help coordinate care for your patients.

Humana does not review preauthorization requests for the following, as physicians 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:

  • Patients treated by Chicago risk and delegated physicians
  • Florida MA HMO and Medicaid HMO plans
  • Health Care Partners commercial and MA HMO plans

Submitting preauthorization requests

If you want preauthorization of initial NPWT for a patient in any market except Puerto Rico, please submit a request via the Availity Provider Portal (view instructions).

If you want to request continued coverage of NPWT, please complete our reauthorization form. Instructions for submitting the reauthorization form are found on its last page.

NPWT reauthorization form (166 KB) (PDF opens in new window)

Texas and Indiana physicians also may use these options:

Texas preauthorization request form (145 KB) (PDF opens in new window)

Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are available online (PDF opens in new window). 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) (PDF opens in new window)

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.

Please note:

  • For Puerto Rico patients with commercial coverage, submit preauthorization requests by fax to 1-800-658-9457. If you have questions about how to submit a request or wish to check the status of a previously submitted request, please call 1-800-611-1474.
  • For Puerto Rico patients with Medicare Advantage coverage, submit preauthorization by fax to 1-800-594-5309 or at Availity.com (registration required). If you have questions about how to submit a request or wish to check the status of a previously submitted request, please call 1-866-488-5995 or 1-866-773-5959.

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.