Medicare AdvantageCoverageMedium impact
Outpatient Rehabilitation (Physical Therapy, Occupational Therapy) - Medicare Advantage (Revised)
Humana·Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Medicare Advantage
Effective date
Jul 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has revised their Medicare Advantage policy for outpatient physical therapy and occupational therapy services, establishing updated coverage determinations, limitations, and documentation requirements. The policy references multiple CMS guidelines and MAC jurisdictions for therapy service coverage.
Action Required
By July 1, 2025: Billing team must review and update outpatient PT/OT billing procedures to align with revised Humana Medicare Advantage policy HUM-1186-008. Ensure documentation meets updated requirements for therapy services and verify compliance with referenced CMS guidelines. Review MAC-specific LCDs for your jurisdiction to ensure proper billing practices.