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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 37 of 422 policies
Policy name Policy category Product Prior authorization required
Cabazitaxel (Jevtana®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Cane or CrutchesEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Capsule endoscopy – wirelessDiagnostic ImagingCoOportunity Health
Iowa
Nebraska
No
Cardiac event monitoringMedical ServicesCoOportunity Health
Iowa
Nebraska
Yes
Cardiac rehabilitationAncillary ServicesCoOportunity Health
Iowa
Nebraska
No
Cardiac resynchronization therapy (CRT)Medical ServicesCoOportunity Health
Iowa
Nebraska
No
Cardiovascular risk assessmentsMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Cardioverter-defibrillator, implantableSurgeryCoOportunity Health
Iowa
Nebraska
No
Carfilzomib (Kyprolis®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Certolizumab (Cimzia®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Cetuximab (Erbitux®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Chelation therapyMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Chemical health residential servicesBehavioral HealthCoOportunity Health
Iowa
Nebraska
Yes
Cleft lip/cleft palateMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Clinical trials – coverage of routine care costsMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Cochlear implants & auditory brainstem implantsSurgeryCoOportunity Health
Iowa
Nebraska
No
Cognitive rehabilitationAncillary ServicesCoOportunity Health
Iowa
Nebraska
Yes
Cold compression therapyEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Collagenase (Xiaflex®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Colorectal cancer (CRC) screening with stool based DNA testing (Cologuard®)Investigational
Laboratory
CoOportunity Health
Iowa
Nebraska
Yes
CommodeEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Compounded medicationsPharmacyCoOportunity Health
Iowa
Nebraska
Yes
Compression support garmentsEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Computed tomography (CT), Magnetic resonance imaging (MRI), and Positron emission tomography (PET) scansDiagnostic ImagingCoOportunity Health
Iowa
Nebraska
No
Computerized dynamic posturographyInvestigationalCoOportunity Health
Iowa
Nebraska
No
Cone Beam CT Scan for Medically-related Dental ServicesDiagnostic ImagingCoOportunity Health
Iowa
Nebraska
Yes
Continuous glucose monitoring systems (CGMS)Equipment/SuppliesCoOportunity Health
Iowa
Nebraska
Yes
Continuous passive motion (CPM) devicesEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
Yes
Continuous positive airway pressure (CPAP)Equipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Cosmetic surgery/treatmentsSurgeryCoOportunity Health
Iowa
Nebraska
Yes
Cranial electrotherapy stimulationBehavioral HealthCoOportunity Health
Iowa
Nebraska
No
Cranial reshaping helmet/bandEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Cryoablation treatment of benign breast fibroadenomasInvestigationalCoOportunity Health
Iowa
Nebraska
No
Cryopyrin-associated periodic syndromes (CAPS) drug therapyPharmacyCoOportunity Health
Iowa
Nebraska
Yes
Cryosurgical ablation for prostate cancerSurgeryCoOportunity Health
Iowa
Nebraska
No
Cryosurgical/radiofrequency ablation of hepatic tumorsSurgeryCoOportunity Health
Iowa
Nebraska
No
CushionsEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Viewing 37 of 422 policies
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CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.