Medical Policy UpdatesCoOportunity 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 search filters
| Policy name | Policy category | Product | Prior authorization required |
|---|---|---|---|
| Cabazitaxel (Jevtana®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Cane or Crutches | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Capsule endoscopy – wireless | Diagnostic Imaging | CoOportunity Health Iowa Nebraska | No |
| Cardiac event monitoring | Medical Services | CoOportunity Health Iowa Nebraska | Yes |
| Cardiac rehabilitation | Ancillary Services | CoOportunity Health Iowa Nebraska | No |
| Cardiac resynchronization therapy (CRT) | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Cardiovascular risk assessments | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Cardioverter-defibrillator, implantable | Surgery | CoOportunity Health Iowa Nebraska | No |
| Carfilzomib (Kyprolis®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Certolizumab (Cimzia®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Cetuximab (Erbitux®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Chelation therapy | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Chemical health residential services | Behavioral Health | CoOportunity Health Iowa Nebraska | Yes |
| Cleft lip/cleft palate | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Clinical trials – coverage of routine care costs | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Cochlear implants & auditory brainstem implants | Surgery | CoOportunity Health Iowa Nebraska | No |
| Cognitive rehabilitation | Ancillary Services | CoOportunity Health Iowa Nebraska | Yes |
| Cold compression therapy | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Collagenase (Xiaflex®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Colorectal cancer (CRC) screening with stool based DNA testing (Cologuard®) | Investigational Laboratory | CoOportunity Health Iowa Nebraska | Yes |
| Commode | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Compounded medications | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Compression support garments | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Computed tomography (CT), Magnetic resonance imaging (MRI), and Positron emission tomography (PET) scans | Diagnostic Imaging | CoOportunity Health Iowa Nebraska | No |
| Computerized dynamic posturography | Investigational | CoOportunity Health Iowa Nebraska | No |
| Cone Beam CT Scan for Medically-related Dental Services | Diagnostic Imaging | CoOportunity Health Iowa Nebraska | Yes |
| Continuous glucose monitoring systems (CGMS) | Equipment/Supplies | CoOportunity Health Iowa Nebraska | Yes |
| Continuous passive motion (CPM) devices | Equipment/Supplies | CoOportunity Health Iowa Nebraska | Yes |
| Continuous positive airway pressure (CPAP) | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Cosmetic surgery/treatments | Surgery | CoOportunity Health Iowa Nebraska | Yes |
| Cranial electrotherapy stimulation | Behavioral Health | CoOportunity Health Iowa Nebraska | No |
| Cranial reshaping helmet/band | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Cryoablation treatment of benign breast fibroadenomas | Investigational | CoOportunity Health Iowa Nebraska | No |
| Cryopyrin-associated periodic syndromes (CAPS) drug therapy | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Cryosurgical ablation for prostate cancer | Surgery | CoOportunity Health Iowa Nebraska | No |
| Cryosurgical/radiofrequency ablation of hepatic tumors | Surgery | CoOportunity Health Iowa Nebraska | No |
| Cushions | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
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