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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 343 policies
Policy name Policy category Product Prior authorization required
Early intensive developmental and behavioral intervention (EIDBI) - Minnesota Health Care Programs Behavioral Health
MHCP
Yes
Early intensive intervention services for autism - MN Behavioral Health
Minnesota
Yes
Eating disorder coverage criteria Behavioral Health
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Eculizumab (Soliris®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Eculizumab (Soliris®) - 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
No
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
Epidural steroid injections (ESI) for low back pain Medical Services
Spine
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
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 Equipment/Supplies
Minnesota
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 17 of 343 policies