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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 moreā€¦

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 18 of 325 policies
Policy name Policy category Product Prior authorization required
Health education Ancillary Services
Administrative
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Hearing aids Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Hearing aids - Minnesota Health Care Programs Equipment/Supplies
MHCP
No
Heart failure pressure sensor, implantable (i.e., CardioMEMS HF System) Investigational
Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Hemangioma treatment Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Hereditary angioedema (HAE) drug therapy Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Hereditary angioedema (HAE) drug therapy - Minnesota Health Care Programs Pharmacy
MHCP
Yes
Home care services - waivered services - Minnesota Health Care Programs Ancillary Services
MHCP
Yes
Home health service Ancillary Services
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Home health service - Minnesota Health Care Programs Ancillary Services
Medical Services
MHCP
Yes
Home Hospice services Ancillary Services
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Home phototherapy-full body cabinet Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Home phototherapy-full body cabinet-Minnesota Health Care Programs Equipment/Supplies
MHCP
Yes
Hospice services - Iowa Ancillary Services
Iowa
Yes
Hospice services - Minnesota Health Care Programs Ancillary Services
MHCP
Yes
Hospital bed Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Hospital bed - Minnesota Health Care Programs Equipment/Supplies
MHCP
Yes
Hyperbaric oxygen therapy Ancillary Services
Medical Services
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 18 of 325 policies