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
Radioactive (Y-90) liver tumor embolization	Medical Services	CoOportunity Health Iowa Nebraska	No
Radiofrequency ablation (RFA) for Barrett's esophagus	Surgery	CoOportunity Health Iowa Nebraska	No
Radiofrequency ablation/applications	Medical Services	CoOportunity Health Iowa Nebraska	No
Radiofrequency ablative (RFA) denervation procedures for chronic facet-mediated neck & back pain	Medical Services Spine	CoOportunity Health Iowa Nebraska	Yes
Radium 223 (Xofigo®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Ramucirumab (Cyramza®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Recent Food and Drug Administration (FDA) approved medications coverage policy	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Reconstructive surgery	Surgery	CoOportunity Health Iowa Nebraska	Yes
Reduction mammoplasty	Surgery	CoOportunity Health Iowa Nebraska	Yes
Repetitive transcranial magnetic stimulation	Behavioral Health	CoOportunity Health Iowa Nebraska	No
Repose® tongue and hyoid suspension system	Surgery	CoOportunity Health Iowa Nebraska	No
Respiratory assist device (RAD)	Equipment/Supplies	CoOportunity Health Iowa Nebraska	No
Rhinoplasty and septorhinoplasty	Surgery	CoOportunity Health Iowa Nebraska	Yes
Rituximab (Rituxan®)	Pharmacy	CoOportunity Health Iowa Nebraska	Yes
Rope and pulley exerciser	Equipment/Supplies	CoOportunity Health Iowa Nebraska	No