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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 moreā€¦

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 14 of 321 policies
Policy name Policy category Product Prior authorization required
Walkers Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Walkers - Minnesota Health Care Programs Equipment/Supplies
MHCP
No
Wearable cardioverter defibrillator and non-wearable automatic external defibrillator Equipment/Supplies
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Wearable cardioverter defibrillator and non-wearable automatic external defibrillator - Minnesota Health Care Programs Equipment/Supplies
MHCP
Yes
Weight loss management Ancillary Services
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Weight loss surgery Surgery
MHCP
Minnesota
North Dakota
South Dakota
Yes
Weight loss surgery - Iowa Surgery
Iowa
Yes
Weight loss surgery - re-operations Surgery
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Weight loss surgery - re-operations - Iowa Surgery
Iowa
Yes
Wheelchairs - mobility assistive equipment (MAE) Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Wheelchairs - mobility assistive equipment (MAE) - Minnesota Health Care Programs Equipment/Supplies
MHCP
Yes
Wigs Equipment/Supplies
MHCP
Minnesota
Yes
Wigs - Iowa Equipment/Supplies
Iowa
Yes
Wigs - North Dakota - South Dakota - Wisconsin Equipment/Supplies
North Dakota
South Dakota
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 14 of 321 policies