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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 27 of 422 policies
Policy name Policy category Product Prior authorization required
Immune globulin therapyPharmacyCoOportunity Health
Iowa
Nebraska
Yes
ImmunizationsPharmacy
Preventive
CoOportunity Health
Iowa
Nebraska
No
Implantable vagus nerve stimulation (VNS)Surgery
Behavioral Health
CoOportunity Health
Iowa
Nebraska
Yes
In vitro fertilization (IVF) and other advanced assisted reproductive technology (ART)Medical ServicesCoOportunity Health
Iowa
Nebraska
No
In-exsufflation devicesEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
In-home mental health psychotherapy servicesBehavioral HealthCoOportunity Health
Iowa
Nebraska
Yes
Infertility diagnosis – femaleMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Infertility diagnosis – maleMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Infertility treatment – femaleMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Infertility treatment – maleMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Infliximab (Remicade®)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Insulin pumpsEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Intensive dietary counseling for obesity for adultsAncillary Services
Medical Services
CoOportunity Health
Iowa
Nebraska
No
Intensive early intervention behavioral therapy (IEIBT)Behavioral HealthCoOportunity Health
Iowa
No
Interferential current stimulation (IFC)Equipment/Supplies
Investigational
CoOportunity Health
Iowa
Nebraska
No
Intermittent positive pressure breathing (IPPB)Equipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Interspinous process decompression to treat spinal stenosis (X–STOP®)SurgeryCoOportunity Health
Iowa
Nebraska
No
Intra-articular Hyaluronan (Viscosupplementation)PharmacyCoOportunity Health
Iowa
Nebraska
Yes
Intraocular lens (IOL) implant after cataract surgerySurgeryCoOportunity Health
Iowa
Nebraska
No
Intraoperative monitoring (IOM) of electromyographic (EMG) responses during spinal surgerySurgeryCoOportunity Health
Iowa
Nebraska
No
Intrathecal baclofenMedical ServicesCoOportunity Health
Iowa
Nebraska
No
Intravenous (IV) therapy and pump suppliesEquipment/SuppliesCoOportunity Health
Iowa
Nebraska
No
Investigational servicesInvestigational
Behavioral Health
CoOportunity Health
Iowa
Nebraska
Yes
Investigational services - list of non-covered servicesInvestigational
Behavioral Health
Spine
CoOportunity Health
Iowa
Nebraska
No
Investigational services – category III codesInvestigationalCoOportunity Health
Iowa
Nebraska
Yes
IontophoresisMedical Services
Equipment/Supplies
CoOportunity Health
Iowa
Nebraska
No
Ipilimumab (Yervoy™)PharmacyCoOportunity Health
Iowa
Nebraska
No
Viewing 27 of 422 policies
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