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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 17 of 325 policies
Policy name Policy category Product Prior authorization required
Gender reassignment surgery Surgery
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Gender-confirming surgery – Minnesota Health Care Programs Surgery
MHCP
Yes
Genetic Testing Ancillary Services
Genetics
Laboratory
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing for Arrhythmias and Cardiomyopathies Laboratory
Genetics
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing for Cancer Predisposition Genetics
Ancillary Services
Laboratory
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing for Connective Tissue, Skeletal, and Integumentary Disorders Laboratory
Genetics
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing for Gastrointestinal Disorders Laboratory
Genetics
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing: Carrier Screening, Prenatal Screening, Prenatal Diagnosis, and Infertility Evaluation Genetics
Laboratory
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Genetic Testing: Coagulation Disorders and Cardiovascular Risk Assessments Laboratory
Genetics
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing: Molecular Profiling Assays for Cancer Management Genetics
Laboratory
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing: Neurological, Developmental, and Sensory Disorders and Congenital Anomalies Genetics
Laboratory
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Genetic Testing: Pharmacogenetics Genetics
Laboratory
Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Golimumab (Simponi ARIA®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Golimumab (Simponi ARIA®) - Minnesota Health Care Programs Pharmacy
MHCP
Yes
Growth deficiency therapy Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Yes
Growth hormone drugs - Wisconsin Pharmacy
Wisconsin
Yes
Gynecomastia surgery Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
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 17 of 325 policies