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
Obinutuzumab (Gazyva®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Occipital Nerve Injections or Radiofrequency Ablation (RFA) to treat Cervicogenic Headache and Occipital Neuralgia	Medical Services Investigational	CoOportunity Health Iowa Nebraska	Yes
Ofatumumab (Arzerra®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Omacetaxine mepesuccinate (Synribo®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Omalizumab (Xolair®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Oncotype DX™ assay for breast cancer recurrence	Laboratory Genetics	CoOportunity Health Iowa Nebraska	No
Oral appliances for sleep disorders	Equipment/Supplies	CoOportunity Health Iowa Nebraska	Yes
Orthognathic surgery	Medical Dental	CoOportunity Health Iowa Nebraska	No
Orthotics/braces	Equipment/Supplies	CoOportunity Health Iowa Nebraska	No
Ostomy supplies	Equipment/Supplies	CoOportunity Health Iowa Nebraska	No
Otoplasty	Surgery	CoOportunity Health Iowa Nebraska	Yes
Outdoor behavioral health programs	Behavioral Health	CoOportunity Health Iowa Nebraska	Yes
Ovarian cancer screening	Medical Services	CoOportunity Health Iowa Nebraska	No
Oximeter	Equipment/Supplies	CoOportunity Health Iowa Nebraska	No
Oxygen	Equipment/Supplies	CoOportunity Health Iowa Nebraska	No