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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 19 of 340 policies
Policy name Policy category Product Prior authorization required
Targeted case management eligibility - adult - Minnesota Health Care Programs Behavioral Health
MHCP
No
Targeted case management eligibility - child - Minnesota Health Care Programs Behavioral Health
MHCP
No
Telehealth - North Dakota Administrative
North Dakota
No
Telehealth/ telemedicine Administrative
Iowa
Minnesota
South Dakota
Wisconsin
No
Telemedicine - Minnesota Health Care Programs Administrative
MHCP
No
Temporomandibular disorder (TMD) treatments Medical Dental
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Termination of pregnancy Administrative
Medical Services
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Termination of pregnancy - Minnesota Health Care Programs Administrative
Medical Services
MHCP
No
Third party payments Administrative
Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Tick borne illness laboratory testing Laboratory
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Tildrakizumab-asmn (Ilumya™) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Tocilizumab (Actemra®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Transcutaneous electrical nerve stimulator (TENS) unit Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Transcutaneous electrical nerve stimulator (TENS) unit - Minnesota Health Care Programs Equipment/Supplies
MHCP
No
Transplant travel benefits Administrative
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Transplants - effective 1/1/19 Transplants
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Transplants - retire 12/31/18 Transplants
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Type I Gaucher disease enzyme replacement therapy: imiglucerase (Cerezyme®), velaglucerase (Vpriv®), telaglucerase (Elelyso®) and eliglustat tartrate (Cerdelga®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Type I Gaucher disease enzyme replacement therapy: imiglucerase (Cerezyme®), velaglucerase (Vpriv®), telaglucerase (Elelyso®) and eliglustat tartrate (Cerdelga®) - 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 19 of 340 policies