Humana will no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage, effective Dec. 18, 2017. Following are some important details about this change: While preauthorization will no longer be required, visit limits and other plan provisions (e.g., referrals) will still apply. Referrals should be submitted to Humana via Availity.com (registration required) for prompt processing. Physicians and other health care professionals may be asked to submit medical records to substantiate the medical necessity of services that have been provided. For additional information and to access the Humana Medical Coverage

Since Congress did not repeal the annual therapy cap or extend the therapy cap exception process into 2018, most outpatient therapy settings will now be dealing with a hard therapy cap of $2010.00 for physical therapy and speech-language pathology services combined and a separate $2010.00 for occupational therapy services. Why did I say most outpatient therapy settings will be dealing with a hard therapy cap in calendar year 2018? That’s because outpatient hospitals, but not critical access hospitals (CAHs), will be exempt from the 2018 annual therapy cap. Continue reading below to see why outpatient hospitals, but not CAHs, are