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HealthPartners

Coverage criteria policies

Protective helmets

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for protective helmets.

Coverage

Protective helmets are not considered medically necessary and are therefore not covered.

Indications that are not covered

  1. Protective helmets, including but not limited to bicycle, ski, skateboarding and motorcycle helmets are not covered.
  2. Helmets that primarily have customary uses other than medical treatment also are not covered.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.

The services associated with these codes do not require prior authorization:

Codes

Description

A8000

Helmet, protective, soft, prefabricated, includes all components and accessories

A8001

Helmet, protective, hard, prefabricated, includes all components and accessories

A8002

Helmet, protective, soft, custom fabricated, includes all components and accessories

A8003

Helmet, protective, hard, custom fabricated, includes all components and accessories

A8004

Soft interface for helmet, replacement only

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor

For in-network benefits to apply, item must be received from a contracted vendor or provider.

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Policy activity

  • 10/08/2002 - Date of origin
  • 06/01/2018 - Effective date
Review date
  • 02/2018
Revision date
  • 05/11/2018

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