Humana PT/OT Insurance Policy Limits the Utilization of Significant Therapy Codes


AOTA has become aware of a problematic Humana Physical and Occupational Therapy insurance policy that extensively limits the use of key CPT® codes that occupational therapists currently utilize. It is unknown how or whether this change in coverage was publicized beyond posting on the Humana website. Many of these payment changes may have been effective August 31, 2017, but additional changes were effective January 1, 2018. It is significant to note that these impacts may have already affected practitioners who have administered and billed for these services. Effective with dates of service on and after January 1, 2018, Humana will no longer pay for the following CPT codes:

  • 97026—Infrared
  • 97113—Aquatic therapy
  • 97150—Group therapy
  • 97533—Sensory integrative techniques
  • 97537—Community/Work reintegration therapy
  • 97545—Work hardening/conditioning; initial 2 hours
  • 97546—Work hardening/conditioning; each additional hour

AOTA is currently reviewing this policy and will be reaching out to Humana to advocate against these exclusions.