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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 9 of 320 policies
Policy name Policy category Product Prior authorization required
Radiofrequency ablative (RFA) denervation procedures for chronic facet-mediated neck and back pain Medical Services
Spine
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Recent Food and Drug Administration (FDA) approved medications coverage policy Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Reconstructive surgery Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Reduction mammoplasty Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Repetitive transcranial magnetic stimulation Behavioral Health
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Repetitive transcranial magnetic stimulation - Minnesota Health Care Programs Behavioral Health
MHCP
No
Reslizumab (Cinqair®) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Rhinoplasty and septorhinoplasty Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Rituximab (Rituxan®, Rituxan Hycela®) Pharmacy
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 9 of 320 policies