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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 343 policies
Policy name Policy category Product Prior authorization required
Vagus Nerve Stimulation (VNS) Behavioral Health
Surgery
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Varicose vein procedures Surgery
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Vedolizumab (Entyvio®) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Vedolizumab (Entyvio®) - Minnesota Health Care Programs Pharmacy
MHCP
Yes
Ventricular assist devices (VADs) & Total artificial hearts Surgery
Transplants
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Ventricular Assist Devices (VADs) & Total Artificial Hearts – Minnesota Health Care Programs Surgery
Transplants
MHCP
Yes
Vision care services Medical Services
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Vision care services - Minnesota Health Care Programs Medical Services
MHCP
No
Vision therapy / orthoptics Ancillary Services
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Vision therapy / orthoptics – Minnesota Health Care Programs Ancillary Services
MHCP
Yes
Voretigene neparvovec-rzyl (Luxturna™) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Voretigene neparvovec-rzyl (Luxturna™) – 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 12 of 343 policies