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 more…

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 name	Policy category	Product	Prior authorization required
Gender reassignment surgery	Surgery	CoOportunity Health Iowa Nebraska	Yes
Genetic counseling	Ancillary Services Genetics	CoOportunity Health Iowa Nebraska	No
Genetic testing for breast/ovarian cancer predispostion (BRCA genetic testing)	Laboratory	CoOportunity Health Iowa Nebraska	Yes
Genetic testing for hereditary cardiac and cardiovascular disease	Laboratory	CoOportunity Health Iowa Nebraska	Yes
Genetic testing for hereditary colorectal cancer susceptibility	Laboratory Genetics	CoOportunity Health Iowa Nebraska	Yes
Genetic testing for idiopathic scoliosis – ScoliScore™	Laboratory Genetics	CoOportunity Health Iowa Nebraska	No
Genetic testing for reproductive planning and prenatal diagnosis	Laboratory Genetics	CoOportunity Health Iowa Nebraska	No
Glaucoma treatment: minimally invasive glaucoma surgery devices	Investigational Medical Services Surgery	CoOportunity Health Iowa Nebraska	No
Golimumab (Simponi ARIA®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
GraftJacket® regenerative tissue matrix	Investigational	CoOportunity Health Iowa Nebraska	No
Growth deficiency therapy	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Guest houses	Other	CoOportunity Health Iowa Nebraska	No
Gynecomastia surgery for males	Surgery	CoOportunity Health Iowa Nebraska	Yes