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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 11 of 325 policies
Policy name Policy category Product Prior authorization required
Maintenance care Other
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Medical cannabis Administrative
Pharmacy
Minnesota
No
Medically necessary/medical necessity Medical Services
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Medication therapy disease management program Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Medications for risk reduction of primary breast cancer in women Pharmacy
Preventive
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Mepolizumab (Nucala®) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Mesenchymal stem cell therapy for orthopedic indications Investigational
Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Minimally invasive and laser spine procedures Spine
Investigational
Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Minimum/maximum drug dosage Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Mucopolysaccharidoses (MPS) drug therapy Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Mucopolysaccharidoses (MPS) drug therapy - Minnesota Health Care Programs Pharmacy
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 11 of 325 policies