Medical Policy UpdatesHealthPartners 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
| Policy name | Policy category | Product | Prior authorization required |
|---|---|---|---|
| Early intensive intervention services for autism - MN |
Behavioral Health |
Minnesota |
Yes |
| Eating disorders |
Behavioral Health |
Iowa MHCP Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Eculizumab (Soliris®) and ravulizumab-cwvz (Ultomiris™) |
Pharmacy |
Iowa Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Eculizumab (Soliris®) and ravulizumab-cwvz (Ultomiris™) - Minnesota Health Care Programs |
Pharmacy |
MHCP |
Yes |
| Edaravone (Radicava®) |
Pharmacy |
Iowa Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Edaravone (Radicava®) – Minnesota Health Care Programs |
Pharmacy |
MHCP |
Yes |
| Elapegademase-lvlr (Revcovi™) |
Pharmacy |
Iowa MHCP Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Electric tumor treatment fields (ETTF) to treat glioblastoma (Optune)™ |
Equipment/Supplies |
Iowa Minnesota North Dakota South Dakota Wisconsin |
No |
| Electric tumor treatment fields (ETTF) to treat glioblastoma (Optune™) - Minnesota Health Care Programs |
Equipment/Supplies |
MHCP |
No |
| Emapalumab-lzsg (Gamifant®) |
Pharmacy |
Iowa MHCP Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Epidural steroid injections (ESI) for low back pain |
Medical Services Spine |
Iowa MHCP Minnesota North Dakota South Dakota Wisconsin |
No |
| Esketamine (Spravato™) |
Pharmacy |
Iowa MHCP Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Etelcalcetide (Parsabiv™) – Minnesota Health Care Programs |
Pharmacy |
MHCP |
Yes |
| Eteplirsen (Exondys 51™) |
Pharmacy |
Iowa Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Exondys 51™ - Minnesota Health Care Programs |
Pharmacy |
MHCP |
Yes |
| Eye surgery - refractive |
Surgery |
Iowa MHCP Minnesota North Dakota South Dakota Wisconsin |
Yes |
| Eyewear |
Equipment/Supplies Administrative |
Iowa Minnesota North Dakota South Dakota Wisconsin |
No |
| Eyewear - Minnesota Health Care Programs |
Equipment/Supplies |
MHCP |
No |
| Eyewear for children |
Administrative Equipment/Supplies |
Minnesota Wisconsin |
No |