Thursday, 4 October 2012

How to get Authorization from OrthoNet for Spinal Surgery and Pain Management Programs for Humana?

Humana has delegated the precertification of spine surgery in any setting as well as pain management procedures (not including trigger point injections) in all settings to OrthoNet. These procedures and their CPT codes are listed on the applicable Humana Prior Authorization List which can be viewed at Humana’s website

We need to submit the Spinal Surgery and Pain Management Programs request form to OrthoNet and need to fill the below information. Its need to be fax #1-800-605-5345

Provider Information
  • Provider Name
  • Street Address
  • City
  • State
  • Zip
  • Telephone Number
  • Fax Number
  • Fax Date
  • Number of Pages faxed
  • NPI
  • Provider Tax Id number
Patient Information
  • First Name
  • Last Name
  • Humana Member ID Number
  • Date of Birth
  • Diagnosis code
Request Information
  • Request for Pain Region
  • Spinal Region
  • Has the patient had prior spinal surgery?
  • Is this the first epidural steroid or facet injection for this patient?
  • Is the MR/CT report attached to this request?
  • CPT Code(s)
  • Requested Facility for surgery/Procedure(s)
  • Anticipated Date of Service(s)
  • City
  • State
  • Telephone Number
You can retrieve this Authorization template in


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