CurrentHealthPartnersPolicy N/A

Cardiology, Musculoskeletal and Advanced Imaging Services Prior Authorization List of Services

List of services and CPT/HCPCS codes that require prior authorization through Cohere Health for specified HealthPartners plans; intended for providers to identify services that may need authorization and guidance on where Medicare/Cohere criteria apply.

Policy Summary

PayerHealthPartners

PolicyCardiology, Musculoskeletal and Advanced Imaging Services Prior Authorization List of Services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization through Cohere Health for the listed cardiovascular, musculoskeletal/orthopedic, and advanced imaging services when treating members of the specified plans.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

11document chunks

~400+listed procedure and HCPCS/CPT codes (approx.)

4plans requiring prior authorization via Cohere

Coverage and Applicability

Prior authorization applicability

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

The codes listed in this document are provided for informational purposes only and do not guarantee that a service is a covered benefit or that a provider will be reimbursed. Plan documents (including benefit booklets and contract language) govern coverage determinations and reimbursement when there is any discrepancy between this information and your specific plan. For questions about Medicare coverage criteria or a copy of a Medicare coverage policy, contact Member Services at the numbers listed in the plan documents.

Code Lists by Service Group

Computed Tomography (CT)CPT

70450	CT codes (listed)
70460	CT codes (listed)
70470	CT codes (listed)
70480	CT codes (listed)
70481	CT codes (listed)
70482	CT codes (listed)
70486	CT codes (listed)
70487	CT codes (listed)
70488	CT codes (listed)
70490	CT codes (listed)

1–10 of 45

1/5

Computed Tomography Angiography (CTA)CPT

70496	Computed Tomography Angiography (CTA)
70498	Computed Tomography Angiography (CTA)
71275	CTA
73706	CTA
75635	CTA

Magnetic Resonance Angiography (MRA)CPT

70544	Magnetic Resonance Angiography (MRA)
70545	MRA
70546	MRA
70547	MRA
70548	MRA
70549	MRA
71555	MRA
72159	MRA
72198	MRA
73225	MRA

1–10 of 30

1/3

Magnetic Resonance Imaging (MRI) and MRCPCPT|HCPCS

74181	MRI Abdomen and MRCP
74182	MRI Abdomen and MRCP
74183	MRI Abdomen and MRCP
S8037	MRI Abdomen and MRCP
70336	MRI
70540	MRI
70542	MRI
70543	MRI
70551	MRI
70552	MRI

1–10 of 41

1/5

Positron Emission Tomography (PET)CPT|HCPCS

78608	Positron Emission Tomography (PET)
78609	PET
78812	PET
78813	PET
78814	PET
78815	PET
78816	PET
G0219	PET
G0235	PET
G0252	PET

Transcatheter Aortic Valve Replacement (TAVR)CPT

33361	Transcatheter Aortic Valve Replacement (TAVR)
33362	TAVR
33363	TAVR
33364	TAVR
33365	TAVR
33366	TAVR

Plans requiring Cohere prior authorization

Plans requiring Cohere prior authorizationFully Insured Commercial HealthPartners plans; Self-Insured Level Funded Commercial HealthPartners plans; Minnesota Health Care Programs (PMAP, MSC+, MSHO) offered by HealthPartners; Medicare Advantage plans offered by HealthPartners

Note about other self-insured plansPrior authorization through HealthPartners may still be required for other self-insured plans; refer to HealthPartners coverage criteria for related policies.

Medicare guidanceMedicare Advantage coverage rules follow CMS NCDs/LCDs, other CMS guidance, and Cohere Medicare Advantage Guidelines when CMS guidance is absent.

Provider Requirements and Actions

Prior Authorization

Prior Authorization Required

Prior authorization is required through Cohere Health for the listed Cardiovascular, Musculoskeletal/Orthopedic, and Advanced Imaging services for specified HealthPartners plans. This applies to Fully Insured Commercial, Self-Insured Level Funded Commercial, Minnesota Health Care Programs (PMAP, MSC+, MSHO) and Medicare Advantage plans offered by HealthPartners. Codes are informational and do not guarantee coverage or payment.

Prior authorization must be obtained through Cohere Health for services listed in the policy.
Prior authorization requirements may differ for other self-insured plans; check HealthPartners for plan-specific rules.

Note

Provider Action — Authorization Workflow

Providers: obtain authorizations and follow Cohere Health workflows. Failure to follow authorization processes may delay care or result in claim denials.

Use Cohere Health for the specified services and plans.
Confirm plan-level prior authorization requirements before scheduling services.

Documentation Required

Where to Find Criteria and Documentation

Consult the Cohere Guidelines (Cohere Guidelines All Specialties - Payer Information) for the specific utilization management criteria and the documentation required to support prior authorization requests. For Medicare Advantage cases, CMS NCDs/LCDs and other CMS guidance take precedence when applicable; Cohere Medicare Advantage Guidelines fill gaps when CMS guidance is absent.

Cohere Guidelines contain clinical criteria and required documentation for each service.
For Medicare Advantage, follow CMS NCDs/LCDs, Medicare Benefit Policy Manual, MLN guidance, then Cohere Medicare Advantage Guidelines as applicable.

Denial Risk

Prior Authorization Requirement — Denial Risk

Services may be denied if required prior authorization is not obtained. Lack of required prior authorization can affect coverage and reimbursement — obtain authorization through Cohere Health before providing the listed services for affected plans.

Claims for services performed without required prior authorization may be denied.
Confirm authorization is in place and documented prior to service to avoid denial risk.

Definitions and Vendor

Cohere Health

DefinitionCohere Health is the utilization management vendor HealthPartners uses to provide prior authorization services for select Cardiology, Musculoskeletal and Advanced Imaging services.

Where to find criteriaCohere's specific criteria may be accessed at 'Cohere Guidelines All Specialties - Payer Information'.

Role with Medicare AdvantageCohere Medicare Advantage Guidelines are used when CMS guidance is absent or not fully established, alongside NCDs/LCDs and other CMS publications.

Plans requiring prior authorization

Fully Insured CommercialFully Insured Commercial HealthPartners plans require prior authorization through Cohere for the listed services and codes.

Self-Insured Level Funded CommercialSelf-Insured Level Funded Commercial HealthPartners plans require prior authorization through Cohere for the listed services and codes.

Minnesota Health Care ProgramsMinnesota Health Care Programs (PMAP, MSC+, MSHO) offered by HealthPartners require prior authorization through Cohere for the listed services and codes.

Medicare AdvantageMedicare Advantage plans offered by HealthPartners require prior authorization through Cohere for the listed services and codes.