Plan-specific application

Prior Authorization Required — Plan-specific application. The full list of prior authorization requirements applies to Humana MA HMO (including HMO POS) and MA PPO plans. Independent physician associations (IPAs) or other risk networks with delegated services must follow their IPA or network processes for requests and for services by non-contracted providers. Humana MA PFFS plans do not require prior authorization but do request notification; providers may submit an Advance Coverage Determination (ACD) for services not on the prior authorization list. This list does not apply to Humana Medicare Supplement plan policyholders. Verify requirements at Provider.Humana.com (Authorization & Referrals).

• Humana MA HMO and HMO POS: full prior authorization list applies
• Humana MA PPO: full prior authorization list applies
• Humana MA PFFS: prior authorization not required (notification requested); ACD available
• Humana Medicare Supplement: list does not apply

Home Health (One Home Care-managed)

Home health services are managed by One Home Care. Prior authorization requests for the listed home health codes must be submitted to One Home Care per their processes. Codes include (but are not limited to): 99512, 99600, G0151, G0152, G0153, G0155, G0156, G0157, G0158, G0159, G0160, G0161, G0162, G0299, G0300, G0493, G0494, G0495, G0496, G2168, G2169, T1000. Contact One Home Care for submission instructions and any clinical documentation requirements prior to service.

• Managed by One Home Care
• Affected codes: 99512, 99600, G0151–G0162, G0299–G0300, G0493–G0496, G2168–G2169, T1000
• Submit per One Home Care process; verify documentation and timing

Spine services prior authorization routing

Spine services (including spinal fusion, decompression, kyphoplasty, vertebroplasty and related procedures) are now managed by Cohere Health. Submit prior authorization requests through Cohere Health's portal for online submission, or via Cohere Health phone at 833-283-0033 (Mon–Fri, 8 a.m.–8 p.m. ET) or fax 857-557-6787. Expedited/urgent cases can be submitted and monitored on the Cohere portal. Include supporting clinical information at the time of submission to support timely review.

• Managed by Cohere Health
• Portal: Cohere Health (register if not registered)
• Phone: 833-283-0033 (Mon–Fri, 8 a.m.–8 p.m. ET)
• Fax: 857-557-6787
• Expedited/urgent cases monitorable via portal
• Common spine codes: 22837–22849, 22853–22862, 22867–22870, 22899, 27278–27280, 62287, 62330–62331, 62380, 63001–63091, 63101–63103, 63170–63197, 63200, 63250–63273 (see full list)

Therapy services prior authorization routing

Therapy services (physical and occupational) are managed by Cohere Health. Submit authorizations on Cohere Health's website (portal registration required), or by phone at 833-283-0033 (Mon–Fri, 8 a.m.–8 p.m. ET) or fax 857-557-6787. Include relevant clinical documentation with the request. Cohere's portal supports submission and monitoring of expedited/urgent cases.

• Managed by Cohere Health
• Portal: Cohere Health (register if not registered)
• Phone: 833-283-0033 (Mon–Fri, 8 a.m.–8 p.m. ET)
• Fax: 857-557-6787
• Common therapy codes: 97010, 97012, 97014, 97016, 97018, 97022 (see list)
• Expedited/urgent cases monitorable via portal