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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 12 of 321 policies
Policy name Policy category Product Prior authorization required
Natalizumab (Tysabri®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Natalizumab (Tysabri®) - Minnesota Health Care Programs Pharmacy
MHCP
Yes
Necitumumab (Portrazza®) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Nerve conduction studies (using automated devices) Investigational
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Neuromuscular electrical stimulator (NMES) Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Neuropsychological testing Behavioral Health
Medical Services
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Neuropsychological testing - Minnesota Health Care Programs Behavioral Health
Medical Services
MHCP
No
Non-surgical treatment for gender dysphoria Ancillary Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Nusinersen (Spinraza) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Nutrition (medical) therapy - Minnesota Health Care Programs Ancillary Services
MHCP
No
Nutritional support Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Nutritional support -Minnesota Health Care Programs Equipment/Supplies
MHCP
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 12 of 321 policies