Skip to main content
HealthPartners

Coverage criteria policies

HealthPartners has Medical Policies that contain coverage criteria that describe how we make coverage decisions for certain health care 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…

Medicare plans

For Medicare coverage criteria, click here.

For a list of services requiring Medicare prior authorization, click here.

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

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Viewing 33 of 341 policies
Policy name Policy category Product Prior authorization required
Capsule endoscopy Diagnostic Imaging
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Cardiac event monitoring Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Cardiovascular risk assessments Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Category III CPT codes Investigational
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Category III CPT codes – Minnesota Health Care Programs Investigational
MHCP
No
Cerliponase alfa (Brineura®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Cerliponase alfa (Brineura™) – Minnesota Health Care Programs Pharmacy
MHCP
Yes
Certolizumab (Cimzia®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Chemical health residential services - Minnesota Health Care Programs Behavioral Health
MHCP
Yes
Chemical health services Behavioral Health
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Children's residential treatment services - Minnesota Health Care Programs Behavioral Health
MHCP
Yes
Chimeric antigen receptor/genetically engineered T-cell receptor (CAR-T) therapy Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Chiropractic services Medical Services
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Chiropractic services - Minnesota Health Care Programs Medical Services
MHCP
No
Chorionic gonadotropin (Novarel® and Synarel®) – Minnesota Health Care Programs Pharmacy
MHCP
Yes
Chronic pain - multidisciplinary intensive day treatment programs Behavioral Health
Medical Services
Iowa
Minnesota
Wisconsin
Yes
Circumcision - Minnesota Health Care Programs Surgery
MHCP
Yes
Cleft lip/cleft palate Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Clinical trials: coverage of routine care costs Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Cognitive rehabilitation Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Collagenase (Xiaflex®) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Complementary and alternative medicine Administrative
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Compounded medications Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Compression support garments Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Compression support garments - Minnesota Health Care Programs Equipment/Supplies
MHCP
No
Computed tomography (CT), Magnetic resonance imaging (MRI) and Positron emission tomography (PET) scans Diagnostic Imaging
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Continuous passive motion (CPM) devices Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Continuous positive airway pressure (CPAP) Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Continuous positive airway pressure (CPAP) - Minnesota Health Care Programs Equipment/Supplies
MHCP
No
Cosmetic surgery / treatments Surgery
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Cosmetic surgery/treatments - Iowa Surgery
Iowa
Yes
Court-ordered care - mental health Behavioral Health
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Cushions Equipment/Supplies
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Viewing 33 of 341 policies