Skip to main content

Coverage criteria policies

CoOportunity Health has Medical Policies that contain coverage criteria and guidelines that describe how we make coverage decisions for certain health care services and items. Please call our Member Services Department at 1.888.324.2064 if you have any questions.

The information presented regarding coverage criteria and guidelines is regularly updated and is subject to change without notice.  Read moreā€¦

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

Viewing 34 of 420 policies
Policy name Policy category Product Prior authorization required
Abatacept (Orencia)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Abdominoplasty/panniculectomySurgeryCoOportunity Health
Iowa
Nebraska
Yes
Access to outpatient behavioral health servicesBehavioral HealthCoOportunity Health
Iowa
Nebraska
Yes
ActigraphyMedical Services
Investigational
CoOportunity Health
Iowa
Nebraska
No
Actinic keratoses treatmentMedical ServicesCoOportunity Health
Iowa
Nebraska
No
AcupunctureAncillary ServicesCoOportunity Health
Iowa
Nebraska
No
Ado-trastuzumab (Kadcyla®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
AdoptionOtherCoOportunity Health
Iowa
Nebraska
No
Advanced drug therapy for pulmonary hypertension: epoprostenol (generic, Flolan® and Veletri®), treprostinil (Remodulin® null), iloprost (Ventavis®) and sildenafil injection (Revatio®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Air compressorEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Air-fluidized specialty bed (group III)Equipment/SuppliesCoOportunity Health
Iowa
Nebraska
Yes
Airway clearance system/chest compression generator systemEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
Yes
Alemtuzumab (Lemtrada™)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Allergy testing immunotherapyMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Allograft transplant for orthopedic procedures of the knee (e.g., DeNovo®NT)Investigational
Medical Services
Surgery
CoOportunity Health
Iowa
Nebraska
Yes
Alopecia areata treatmentMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Alpha-1 antitrypsin (AAT) deficiency enzyme replacement therapy: Alpha-1 Proteinase Inhibitor (Aralast NP®, Glassia®, Prolastin®-C and Zemaira®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Ambu bagEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Ambulance & medical transportationAncillary ServicesCoOportunity Health
Iowa
Nebraska
No
Ankle replacement surgerySurgeryCoOportunity Health
Iowa
Nebraska
Yes
Anti-nausea wristbandEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
ApheresisMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Apnea monitorEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Aqua K pad and pumpEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Artificial insemination (AI) or intra-uterine insemination (IUI)Medical ServicesCoOportunity Health
Iowa
Nebraska
No
Artificial intervertebral disc replacement - cervicalSurgery
Spine
Medical Services
CoOportunity Health
Iowa
Nebraska
Yes
Artificial intervertebral disc replacement - lumbarInvestigational
Spine
CoOportunity Health
Iowa
Nebraska
No
Asparaginase Erwinia chrysanthemi (Erwinaze®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Augmentative communication deviceEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Autism services - NebraskaBehavioral HealthCoOportunity Health
Nebraska
Yes
Autologous bone marrow grafting (ABMG) for osteonecrosisSurgeryCoOportunity Health
Iowa
Nebraska
No
Autologous chondrocyte implantation (ACI)Medical ServicesCoOportunity Health
Iowa
Nebraska
No
Autologus platelet rich plasma (PRP) injectionsMedical Services
Investigational
CoOportunity Health
Iowa
Nebraska
No
AutopsyAncillary ServicesCoOportunity Health
Iowa
Nebraska
No
Viewing 34 of 420 policies
Loading...Loading...

CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.