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HealthPartnersCommercial · Coverage · Reimbursement · MN · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +4 moreMedium impact

Fast Facts Newsletter - April (Special Edition) 2026

Effective date
Jun 1, 2026
Identified
Nov 6, 2026

Summary

This historical HealthPartners Fast Facts special edition (issued 2026-04-01, first detected 2026-11-06) reports several provider-facing changes: some coverage policies were retired, revised or renamed Reported as already effective in the historical source, the InterQual Home Care criteria for Commercial and Medicaid plans and Cohere Health criteria for Commercial/Medicaid and Medicare Advantage hip and knee arthroplasty take effect 06/01/2026, a Technology-Enabled Surgical Procedures reimbursement policy expands to musculoskeletal procedures effective 6/1/2026, and several services were added to the investigational/non-covered list Reported as already effective in the historical source. Because the analysis date (2026-11-06) is after the 06/01/2026 dates, those changes should be treated as already effective; the billing team should verify current applicability in the live policies rather than treat them as pending.

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What to do

Action · 5 steps
01Already effective (immediately upon the 04/01/2026 notice, and 06/01/2026 for the dated items; both are historical as of 2026-11-06, so verify current applicability online rather than completing a past deadline): Billing team and providers: review the investigational/non-covered list changes (HCPCS E0767, CPT 36836/36837, HCPCS E0743/A4544, CPT 15011-15018/HCPCS C8002/C1832) and, for affected HealthPartners members, stop scheduling or billing these services without confirming coverage, and tell providers and front desk staff in advance so patients who still want them are counseled about possible non-coverage (use an ABN only if the patient is under Traditional Medicare, or a patient waiver where the source allows).
02Billing team: update charge entry and claim edits to reflect the retired Reconstructive Surgery and Hospital bed - Minnesota Health Care Programs policies and the renamed Cosmetic and reconstructive procedures policy, pointing staff to the revised Hospital bed criteria link.
03Billing team: for the 06/01/2026 items (Home health InterQual LOC criteria for Commercial/Medicaid; Cohere hip and knee arthroplasty criteria for Commercial/Medicaid and Medicare Advantage; Technology-Enabled Surgical Procedures policy expanded to Computer-Assisted Surgical Navigation for musculoskeletal procedures), confirm the practice's prior authorization tracker and charge entry reflect the current criteria, and direct orthopedic staff to the Cohere Upcoming Policy Changes page to review specifics.
04Front desk and providers: for MSHO and MSC+ members with retroactive enrollment, expect a possible delay in authorizations (the source says they will be entered within 30 days of DHS notice) and contact Service Coordinators at 952-883-7775 for status before scheduling services that depend on an authorization.
05Watch for HealthPartners' next Fast Facts notice for any further updates.

Codes mentioned

E07673683636837E0743A45441501115018C8002C1832

Original notice

Fast Facts Newsletter - April (Special Edition) 2026
healthpartners.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

HealthPartners policiesMN policy changesOrthopedicsPM&R (Physical Medicine & Rehab)Physical TherapyDermatologyWound CareNephrologyNeurologyCode E0767Code 36836Code 36837Code E0743Code A4544Code 15011Code 15018Code C8002Code C1832

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