HealthPartners has Medical Policies that contain coverage criteria that describe how we make coverage decisions for certain healthcare services and items. Which coverage criteria apply to your plan depends upon the state in which the plan was purchased, which is not necessarily your state of residence. For a customized experience, log on to myHealthPartners. For questions, call the Member Services number on the back of your member identification card.
The information regarding coverage guidelines is regularly updated and is subject to change without notice. Read more…
If unsure of the keyword spelling, enter the first three letters of the word followed by an asterisk (*). Example: enter acu* to locate the acupuncture policy.
Policy search filters
| Policy name | Policy category | Product | Prior authorization required |
|---|---|---|---|
| Tanning lights | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Targeted case management eligibility – adult | Behavioral Health | HealthPartners Care Minnesota Wisconsin | No |
| Targeted case management eligibility – child | Behavioral Health | HealthPartners Care Minnesota Wisconsin | No |
| Telavancin (Vibativ®) | Pharmacy | HealthPartners Care Minnesota Wisconsin | Yes |
| Telehealth | Administrative | Minnesota HealthPartners Care Wisconsin | No |
| Temporomandibular disorder (TMD) treatments | Medical Dental | HealthPartners Care Minnesota Wisconsin | Yes |
| Temporomandibular disorder (TMD/TMJ) oral appliances | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Termination of pregnancy | Medical Services | Minnesota | No |
| Termination of pregnancy – Compass for HealthyMN | Medical Services | Minnesota | No |
| Termination of pregnancy – HealthPartners Care | Medical Services | HealthPartners Care | No |
| Thera-Bite | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Thrombo embolic deterrent (TED) stockings – HealthPartners Care | Equipment/Supplies | HealthPartners Care | No |
| Tick borne illness laboratory testing | Laboratory | HealthPartners Care Minnesota Wisconsin | No |
| Tobacco cessation products and programs – HealthPartners care | Medical Services | HealthPartners Care | No |
| Tocilizumab (Actemra®) | Pharmacy | HealthPartners Care Minnesota Wisconsin | Yes |
| Toilet seats, raised or elevated – HealthPartners Care | Equipment/Supplies | HealthPartners Care | No |
| Topical hyperbaric oxygen (THBO) for wound healing | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Tracheostomy supplies | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Traction equipment | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Transanal endoscopic microsurgery | Surgery | HealthPartners Care Minnesota Wisconsin | Yes |
| Transcatheter closure device for heart conditions | Surgery | HealthPartners Care Minnesota Wisconsin | No |
| Transcutaneous Aortic Valve Replacement (TAVR) | Surgery | HealthPartners Care Minnesota Wisconsin | Yes |
| Transcutaneous electrical joint stimulation devices | Equipment/Supplies | HealthPartners Care Wisconsin Minnesota | No |
| Transcutaneous electrical nerve stimulator (TENS) unit | Equipment/Supplies | Minnesota Wisconsin | No |
| Transcutaneous electrical nerve stimulator (TENS) unit – HealthPartners Care | Equipment/Supplies | HealthPartners Care | No |
| Transfer belt | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Transfer board | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Transjugular intrahepatic porto-systemic shunts (TIPS) | Surgery | HealthPartners Care Minnesota Wisconsin | No |
| Transplants | Transplants | HealthPartners Care Minnesota Wisconsin | Yes |
| Transportation services – HealthPartners Care | Ancillary Services | HealthPartners Care | No |
| Transurethral balloon dilation of the prostate | Surgery | HealthPartners Care Minnesota Wisconsin | No |
| Transurethral microwave therapy for the prostate | Surgery | HealthPartners Care Minnesota Wisconsin | No |
| Transurethral needle ablation (TUNA, PROSTIVA™) for benign prostatic hyperplasia | Surgery | HealthPartners Care Minnesota Wisconsin | No |
| Trapeze bar – over bed | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Trastuzumab (Herceptin®) | Pharmacy | HealthPartners Care Minnesota Wisconsin | No |
| Trend event recorder | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Truss | Equipment/Supplies | HealthPartners Care Minnesota Wisconsin | No |
| Tumor chemosensitivity & chemoresistance assays | Investigational | HealthPartners Care Minnesota Wisconsin | No |
| Tumor markers | Medical Services | HealthPartners Care Minnesota Wisconsin | Yes |
| Type I Gaucher disease enzyme replacement therapy: imiglucerase (Cerezyme®) and velaglucerase (Vpriv®) and telaglucerase (Elelyso®) | Pharmacy | HealthPartners Care Minnesota Wisconsin | Yes |
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