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Fast Facts Newsletter - May 2025
Effective date
Not stated in the notice
Identified
Jun 19, 2026
Summary
Effective 07/01/2025, prior authorization is required through Cohere Health for HealthPartners Level Funded Self-Insured Commercial plans for a specific list of cardiovascular and musculoskeletal services, and Cohere Health's coverage criteria will be used for those plans. Also effective 07/01/2025, prior authorization is required under Medicare for Deep Brain Stimulation for Essential Tremor and Parkinson's Disease and for Phrenic Nerve Stimulation, and a new reimbursement policy for add-on code G2211 takes effect.
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What to do
Action · 9 steps
01Already effective 07/01/2025: For Level Funded Self-Insured Commercial plans, dates of service Previously due 7/1/2025 (date passed; verify current applicability) follow HealthPartners' existing policies and processes, and for dates of service after 7/1/2025 providers can submit prior authorization requests to Cohere Health for the cardiovascular and musculoskeletal services on the Cohere list, such as Cardiac Ablation, Knee Arthroplasty, Hip Arthroplasty, Lumbar Spinal Fusion, Spinal Cord Stimulation and Total Disc Arthroplasty.
02Medicare: prior authorization is required for Deep Brain Stimulation for Essential Tremor and Parkinson's Disease and for Phrenic Nerve Stimulation.
03Reimbursement policies: the new policy for add-on code G2211 is effective 7/1/2025, and the Observation Level of Care, Laboratory Services, Transabdominal and Transvaginal Ultrasounds, Superficial Radiation Therapy, Provider-Based Care Management Services and High-Cost Medical Drugs policies are new effective 7/1/2025.
04Airway clearance systems: replacement parts vests (A7025) and hoses (A7026) were added to the covered indications, effective 5/1/2025.
05Walkers under Minnesota Health Care Programs: powered walkers (E0152) are not covered, because they are considered an item of convenience.
06Hospital beds under Minnesota Health Care Programs: all requests for enclosed beds and accessories require an evaluation from an occupational therapist or a behavioral therapist that works directly with the member.
07Wheelchairs under Minnesota Health Care Programs: providers dispensing Group 2 single-power-option wheelchairs or any multiple-power wheelchairs must employ a Rehabilitative Engineering and Assistive Technology Society of America certified Assistive Technology Professional who is directly involved in the selection and fitting.
08Robotic arms: a face-to-face evaluation by a physical or occupational therapist must be documented, and the provider must train the member on the use of the equipment.
09Direct specific patient inquiries about coverage policies to the Medical Policy Intake line at 952-883-5724.
Codes mentioned
A7025A7026E0152G2211
Original notice
Fast Facts Newsletter - May 2025
healthpartners.com · Always check the source before changing claims.
Related changes
See all HealthPartners changes →Fast Facts Newsletter - May 2025HighNo effective date · Medical PolicyFast Facts Newsletter - January 2025HighNo effective date · Medical PolicyFast Facts Newsletter - March 2025MediumEffective May 1, 2025 · Medical PolicyFast Facts Newsletter - July 2025MediumEffective Jul 1, 2025 · PharmacyBrowse every HealthPartners change in the policy list