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 |
|---|---|---|---|
| Palatal implants for obstructive sleep apnea | Surgery | CoOportunity Health Iowa Nebraska | No |
| Pancreas transplantation | Transplants | CoOportunity Health Iowa Nebraska | Yes |
| Panitumumab (Vectibix®) | Pharmacy | CoOportunity Health Iowa Nebraska | No |
| Paraffin bath/portable | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Parenteral therapy | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Patient lifts (Hoyer™, etc) | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Peak flow meter | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Pectus carinatum and pectus excavatum | Surgery | CoOportunity Health Iowa Nebraska | No |
| Pegloticase (Krystexxa®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Pelvic floor electrical stimulator for urinary incontinence | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Pembrolizumab (Keytruda®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Penile implants (penile prosthesis) | Surgery | CoOportunity Health Iowa Nebraska | No |
| Percussor | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Percutaneous tibial nerve stimulation (PTNS) for overactive bladder | Medical Services | CoOportunity Health Iowa Nebraska | Yes |
| Percutaneous vertebroplasty and kyphoplasty | Surgery | CoOportunity Health Iowa Nebraska | No |
| Peripheral nerve block injections - diabetic peripheral neuropathy (chronic pain) | Investigational Medical Services | CoOportunity Health Iowa Nebraska | No |
| Pertuzumab (Perjeta®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Pharmacogenetic testing | Laboratory Behavioral Health Genetics | CoOportunity Health Iowa Nebraska | Yes |
| Phenylketonuria (PKU) food products | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Photodynamic therapy (PDT) for age-related macular degeneration | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Photodynamic therapy (PDT) for head and neck tracheobronchial and esophageal cancer | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Physical and occupational therapy - outpatient habilitative | Ancillary Services | CoOportunity Health Iowa Nebraska | Yes |
| Physical and occupational therapy – rehabilitation | Ancillary Services | CoOportunity Health Iowa Nebraska | Yes |
| Pleural effusion drainage systems | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Pneumatic compression device (e.g., Flexitouch) | Equipment/Supplies | CoOportunity Health Iowa Nebraska | Yes |
| Pneumatic compression device for deep vein thrombosis (DVT) prevention (e.g., SCD Express, ActiveCare+S.F.T.) | Equipment/Supplies | CoOportunity Health Iowa Nebraska | Yes |
| Pompe disease enzyme replacement therapy – alglucosidase alfa (Myozyme® and Lumizyme®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Port wine stain treatment | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Portable/unattended/home sleep tests for the diagnosis of obstructive sleep apnea | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Pralatrexate (Folotyn®) | Pharmacy | CoOportunity Health Iowa Nebraska | Yes |
| Preventive services – Adult | Medical Services Preventive | CoOportunity Health Iowa Nebraska | No |
| Preventive services – children and adolescents | Medical Services | CoOportunity Health Iowa Nebraska | No |
| Private duty aide in hospital or skilled nursing facility (SNF) | Ancillary Services | CoOportunity Health Iowa Nebraska | No |
| Prolotherapy | Investigational | CoOportunity Health Iowa Nebraska | No |
| Prophylactic mastectomy | Surgery | CoOportunity Health Iowa Nebraska | No |
| Prostate specific antigen (PSA) | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Prosthetic and/or stump coverings | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Prosthetic ear/eye | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Prosthetic limb | Equipment/Supplies | CoOportunity Health Iowa Nebraska | Yes |
| Prothrombin time monitoring – home | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
| Proton beam radiation therapy | Medical Services | CoOportunity Health Iowa Nebraska | Yes |
| Pulmonary rehabilitation | Ancillary Services | CoOportunity Health Iowa Nebraska | No |
| Punctal plugs | Equipment/Supplies | CoOportunity Health Iowa Nebraska | No |
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CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.