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Medicare Policies

The following rules apply to Medicare:

Annual Wellness Visit Billing Guidelines

For a list of services requiring prior authorization, click on this link, PA list.

For Medicare coverage criteria, the following applies:

  • National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs) CMS coverage database
  • Published guidance from the Centers for Medicare and Medicaid Services (CMS), including the Medicare Benefit Policy Manual, and MLN Matters publications.

If there is no applicable national or local coverage determination or other CMS guidance, HealthPartners coverage policies will apply.

NOTE: Only items listed in the Prior Authorization (PA) lists require prior authorization.

See Medicare products and additional items/services covered beyond Medicare