Prior Authorization · 2026
Humana Prior Authorization Requirements
A source-backed map of which procedures Humana requires prior authorization for — pulled directly from Humana's own published clinical-policy PDFs and refreshed regularly.
26
procedure codes that require prior auth
31
source-backed PA policy entries
1
commercial plan line
100%
cited to published policy
Does Humana require prior authorization?
Yes. Humana requires prior authorization for a wide range of imaging, surgical, specialty-drug, and outpatient services. d3rx tracks 26 procedure codes that Humana requires PA for (of 30 services we map for this payer), every one tied to a published Humana policy document and last verified April 6, 2026. Look up your exact CPT code below for the verdict, documentation, and policy citation.
Sources
Every Humana verdict on d3rx is extracted from these published policy documents — not generated. Always confirm against the carrier's current policy before submitting.
- Humana Commercial Preauthorization and Notification List (July 2024)
- Humana Medicare Preauthorization and Notification List 2025 - Sleep Studies
Most-requested procedures that need Humana prior auth
High-volume CPT/HCPCS codes Humana requires prior authorization for. Open any code for the full source-backed verdict and documentation checklist.
- CPT 97161PA required
Physical therapy evaluation, low complexity, typically 20 minutes
- CPT 97110PA required
Therapeutic exercises to build strength, flexibility, or endurance
- CPT 27130PA required
Total hip arthroplasty
- CPT 27447PA required
Total knee arthroplasty
- CPT 58571PA required
Abdominal and laparoscopic hysterectomy
- CPT 64493PA required
Site of service - Muscular/skeletal procedures (outpatient hospital/ASC only)
- CPT 66984PA required
Site of service - Cataract surgery (outpatient hospital only)
- CPT 70553PA required
MRI brain with and without contrast
- CPT 72148PA required
MRI lumbar spine without contrast
- CPT 74177PA required
CT, MRI, and MR angiography of abdomen and/or pelvis with various contrast protocols including CT angiography combinations
- CPT 96365PA required
IV infusion for therapy, prevention, or diagnosis, initial up to 1 hour
- CPT 97597PA required
Removal of dead tissue from open wound, first 20 sq cm or less
- CPT 22630PA required
Spinal surgery procedures
- CPT 29827PA required
Arthroscopy procedures with site of service review (except in certain states)
- CPT 33249PA required
Cardiac device procedures including insertion of left ventricular pacing electrode and insertion/replacement of permanent implantable defibrillator system
- CPT 43775PA required
Bariatric surgery procedures
- CPT 63047PA required
Spinal surgery procedures
- CPT 63650PA required
Spinal cord stimulator implantation for pain management
- CPT 67028PA required
Site of service - Eye and ocular adnexa procedures (outpatient hospital only)
- CPT 78816PA required
PET scan with CT of the full body for tumor detection
- CPT 91110PA required
Capsule endoscopy
- CPT 93656PA required
Cardiovascular procedures
- CPT 95810PA required
Laboratory-assisted sleep studies including polysomnography for sleep apnea diagnosis
Humana prior-authorization contacts
Phone
Fax
- 1-877-418-0506
How to get Humana prior authorization approved
- 1Confirm the requirement: look up the exact CPT code above to see whether Humana requires PA and under which plan line.
- 2Gather documentation: clinical notes, history of conservative treatment, imaging/test results, and a clear statement of medical necessity matching the policy criteria.
- 3Submit via the Humana provider portal (or the phone/fax channel for the relevant program), attaching the documentation.
- 4Record the reference number and follow up within 5 business days if no determination is returned. If denied, appeal in writing within 60 days, mirroring the policy's exact criteria language.
Humana prior authorization FAQ
- Does Humana require prior authorization?
- Yes. Humana requires prior authorization for a wide range of imaging, surgical, specialty-drug, and outpatient services. Our source-backed dataset tracks 26 procedure codes that Humana requires prior authorization for, compiled from 2 published Humana policy documents and last verified April 6, 2026. Requirements vary by procedure and plan, so confirm the specific CPT code before scheduling.
- How do I check whether Humana requires prior authorization for a specific CPT code?
- Enter the exact CPT or HCPCS code in the free d3rx PA lookup, or pick from the most-requested procedures listed on this page. Each opens the source-backed verdict for Humana, the documentation required, and a link to the underlying policy PDF.
- What documentation does Humana require for prior authorization?
- Typical requirements include clinical notes, history of conservative treatment, relevant imaging or test results, and a clear statement of medical necessity. The exact documents vary by procedure and are listed on each code's page.
- How long does Humana prior authorization take?
- Standard Humana commercial determinations are generally returned within 5–14 business days for non-urgent requests, and within 72 hours for urgent (expedited) requests, per state-regulated and contractual timelines.
- How do I submit a Humana prior authorization request?
- Submit via the Humana provider portal, or by phone (1-800-444-9137) or fax (1-877-418-0506) for the relevant program. Include the documentation listed on the procedure's page and record the reference number for follow-up.
Draft a Humana prior-auth request — free
Ask D3 pulls from the same source-backed dataset plus denial and appeal playbooks. Get the documentation checklist and a ready-to-send request for any Humana procedure — no signup.
Other payer prior-authorization hubs
Prior authorization disclaimer
This page summarizes Humana prior-authorization data extracted from the carrier's published policy documents for educational purposes. PA requirements change frequently and vary by individual plan. Always verify requirements directly with Humana before performing a procedure. d3rx is not responsible for claim denials or reimbursement issues.