Prior authorization required — how to submit

Prior authorization (also called preauthorization or precertification) is required for specified medications delivered in the provider's office, clinic, outpatient or home setting. Prior authorization for medications may be initiated online via CoverMyMeds, by phone at 866-461-7273 (TTY: 711), or by fax to 888-447-3430; request forms are available on Humana's prior authorization for professionally administered drugs website.

• Online: CoverMyMeds (https://www.covermymeds.health/)
• Phone: 866-461-7273 (TTY: 711), Mon–Fri 8 a.m. – 11 p.m. Eastern
• Fax: 888-447-3430 (request forms available on Humana website)

Urgent services and risks of missing authorization

Urgent or emergent services do not require referrals or prior authorizations; however, failure to obtain required prior authorization for non-urgent services may result in financial penalties to the practice, reduced patient benefits, and possible retrospective medical necessity review.

• Verify benefits and prior authorization requirements with Humana before providing non-urgent services to avoid penalties.

Documentation to include with prior authorization

Submit all relevant clinical and administrative information with prior authorization requests to expedite determination. Required information may include patient demographics, Humana member ID, date of service, HCPCS and diagnosis codes (up to 6), service location, facility and provider TIN/NPI, caller/requester and attending provider contact, and relevant clinical information.

• Patient name, date of birth, Humana member ID
• Date of service or hospital admission
• HCPCS codes and diagnosis codes (primary and secondary), up to 6
• Service location (inpatient, outpatient, home, etc.)
• Facility and provider TIN and NPI, caller/requester name and phone, attending provider phone
• All relevant clinical information (submit at time of request)

Transplant preauthorization routing

Preauthorization requests for transplant-related therapies are reviewed by the Humana National Transplant Network. Submit transplant preauthorization requests by fax to 502-508-9300, by phone at 866-421-5663 (Mon–Fri, 7 a.m.–7 p.m. Central), or by email to transplant@humana.com.

• Fax: 502-508-9300
• Phone: 866-421-5663, Monday–Friday 7 a.m.–7 p.m. Central
• Email: transplant@humana.com

Eculizumab‑aeeb (Bkemv IV) — submission and code

Eculizumab-aeeb (Bkemv IV) requires prior authorization; the entry lists billing code Q5152 and instructs providers to access the fax forms to request preauthorization or provide notification.

• Billing code: Q5152
• Access the fax forms to request preauthorization or provide notification

Belantamab mafodotin (Blenrep) — codes and forms

Belantamab mafodotin (Blenrep) requires prior authorization/notification and is listed with multiple shared/NOC billing codes; providers should access the fax forms to request preauthorization or provide notification.

• Billing codes: C9399, J3490, J3590, J9999
• Shared/NOC codes require corresponding NDC on claims (see billing rules)

Ciltacabtagene autoleucel (Carvykti) — submission and code

Ciltacabtagene autoleucel (Carvykti) requires prior authorization; the entry lists billing code Q2056 and directs providers to access the fax forms to request preauthorization or provide notification.

• Billing code: Q2056
• Access the fax forms to request preauthorization or provide notification

Humana National Transplant Network review — overview

Preauthorization requests for transplant-related therapies will be reviewed by the Humana National Transplant Network; submissions can be made by fax, phone, or email using the contact details and hours provided.

• Fax/phone/email submission options provided for transplant review (see transplant contact details)

Transplant preauthorization — submission methods

Transplant preauthorization requests may be submitted by fax to 502-508-9300, by phone at 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. CT), or by email to transplant@humana.com; requests flagged †† will be routed to this network for review.

• Fax: 502-508-9300
• Phone: 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. Central)
• Email: transplant@humana.com
• †† indicates review by Humana National Transplant Network

General preauthorization/notification submission instruction

For listed medications, providers should 'access the fax forms to request preauthorization or provide notification' as indicated across the list; many entries repeat this instruction and specific request forms are available on Humana's prior authorization website.

• Use the specific fax forms referenced for each medication when requesting preauthorization or providing notification
• Request forms are available on Humana's prior authorization for professionally administered drugs website

Legend — special annotations

Symbols used on the list: * = new preauthorization requirement; † = new-to-market drug addition; ‡ = shared HCPCS/NOC codes require a corresponding NDC billed on all claims; ** = step therapy required through a Humana-preferred drug as part of preauthorization; †† = preauthorization requests reviewed by the Humana National Transplant Network.

• * New preauthorization requirement
• † New-to-market drug addition
• ‡ Shared HCPCS/NOC codes require corresponding NDC on all claims
• ** Step therapy required through a Humana-preferred drug as part of preauthorization
• †† Transplant network review

How to request prior authorization — medication codes and forms

Access the fax forms to request prior authorization or provide notification for the medications listed; each medication entry includes the associated billing code(s) to include with the request.

• Include the medication-specific billing code(s) (e.g., J9353, J3397, J0888) with the authorization request
• Use the fax forms referenced on Humana's prior authorization website

Transplant preauthorization — submission instructions

Transplant preauthorization submissions should follow the Humana National Transplant Network routing: fax 502-508-9300, phone 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. CT), or email transplant@humana.com; these methods are repeated throughout transplant-related entries.

• Fax: 502-508-9300
• Phone: 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. Central)
• Email: transplant@humana.com

Billing requirement & step therapy note

Shared HCPCS codes and 'not otherwise classified' (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims; some medications may also require step therapy through a Humana-preferred drug as part of preauthorization.

• Ensure corresponding NDC is billed on all claims for shared HCPCS/NOC codes (e.g., C9399, J3490)
• Medications marked with ** require step therapy through a Humana-preferred drug as part of preauthorization

Prior authorization request instructions and special notes

When requesting prior authorization, note the combined instructions and special notes: new preauthorization requirements (*), new-to-market notation (†), NDC billing requirement for HCPCS/NOC codes (‡), step therapy notes (**), and transplant network review/contact details (††).

• Include medication annotations and follow the corresponding submission path (e.g., †† routes to transplant network)

Preauthorization flags and contact

Preauthorization flags used on the list: † indicates new-to-market drug; ‡ indicates HCPCS/NOC codes require NDC on claims; ** indicates step therapy required through a Humana-preferred drug; †† indicates review by the Humana National Transplant Network with contact details provided.

• Follow flag-specific requirements when submitting requests and billing claims

General prior authorization instructions and special rules

All shared HCPCS and not otherwise classified codes require a corresponding NDC to be billed on all claims. Step therapy may be required through a Humana-preferred drug as part of preauthorization, and transplant-related preauthorization requests are reviewed by the Humana National Transplant Network (fax/phone/email provided).

• Ensure NDC accompanies shared HCPCS/NOC codes on claims
• Confirm step therapy requirements for medications marked with **
• Transplant submissions: fax 502-508-9300; phone 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. CT); transplant@humana.com

Fax form access — listed drugs (examples)

Access the specified fax forms to request prior authorization or provide notification for the listed drugs — examples across the document include Wainua (C9399, J3490), Xeomin (J0588), Xembify (J1558), and Xenpozyme (J0218).

• Include the listed billing codes with the fax form when submitting requests

Fax form access — oncology/supportive products

Access the fax forms to request prior authorization or provide notification for radiolabeled, oncology, and supportive care products; examples include Zevalin (A9543), Zevaskyn (J3389), Ziextenzo (Q5120), Ziihera (J9276), and Zilretta (J3304).

• Include the product-specific billing code when submitting the fax form