Fast Facts Newsletter - September 2026

By October 15, 2026: (1) Billing team must update system to require prior authorization for reduction mammaplasty (CPT codes to be identified in full policy) for HealthPartners Fully Insured Commercial, Self-Insured Level Funded Commercial, and Minnesota Health Care Program plans—obtain prior auth from HealthPartners before billing to avoid claim denials. (2) Access HealthPartners website at healthpartners.com to review complete text of all Cohere Health revised and new coverage policies effective 11/01/2026 (list includes: Bunionette Surgical Treatments, Cervical Spinal Fusion, Hammertoe/Claw Toe/Mallet Toe Surgical Treatment, Intradiscal procedures, Intrathecal Pain Pumps, Interphalangeal Joint Arthroplasty, Omnibus Codes Musculoskeletal/Pain Management/Cardiovascular, Shoulder Arthroplasty, Spinal Fusion procedures, Laminectomy for Spasticity/AVM, Cardiac Catheterization, Carotid Endarterectomy, Electrophysiological Study, Left Atrial Appendage procedures, Patent Foramen Ovale/Atrial Septal Defect Closure, Transcatheter Mitral Valve Repair/Replacement, Spinal Decompression, External Cardiac Monitoring Devices). (3) Update billing software rules, encounter forms, and coding guidelines to reflect coverage criteria changes for Commercial and Medicaid plans (revisions) and Medicare Advantage plans (revisions and new policies). (4) Identify claims currently in-flight using affected procedures and determine if prior authorization or documentation updates are required under new criteria. (5) Update Observation Level of Care reimbursement procedures with new diagnosis codes per updated policy at healthpartners.com. (6) Notify clinical and coding staff of all changes. Failure to comply will result in claim denials and payment delays.