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HealthPartners: Cohere Medicare Advantage & Commercial/Medicaid Guidelines

Overview

In this article, you can find Cohere guidelines for HealthPartners members with Medicare Advantage (MA) and Commercial / Medicaid coverage. Select a line of business and service below to download the applicable guideline.

Commercial / Medicaid Guidelines

Musculoskeletal Services (Commercial / Medicaid)

Cardiovascular Services (Commercial / Medicaid)

Diagnostic Imaging Services (Commercial / Medicaid)

Site of Service Criteria (Commercial / Medicaid)

Medicare Advantage Guidelines

Musculoskeletal Services (Medicare Advantage)

Cardiovascular Services (Medicare Advantage)

Diagnostic imaging Services (Medicare Advantage)

Upcoming Policy Changes

All services (Commercial / Medicaid)

Musculoskeletal: Effective 8/1/2026

Musculoskeletal: Effective 9/1/2026

Cardiovascular: Effective 9/1/2026

Diagnostic Imaging: Effective 9/1/2026

All services (Medicare Advantage)

Musculoskeletal: Effective 8/1/2026

Musculoskeletal: Effective 9/1/2026

Cardiovascular: Effective 9/1/2026

Diagnostic Imaging: Effective 9/1/2026

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SI Joint Injections Guidelines.pdf
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Cohere Medical Policy - Vertebral Corpectomy.pdf
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Cohere Medical Policy - Vertebral Body Tethering.pdf
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Cohere Medical Policy - Total Disc Arthroplasty.pdf
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Cohere Medical Policy - Thoracolumbar Spinal Fusion with or without Pelvic Fixation.pdf
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Cohere Medical Policy - Thermal Ablation of the Intraosseous Basivertebral Nerve (BVN).pdf
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Cohere Medical Policy - Subchondroplasty.pdf
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Cohere Medical Policy - Spinal Decompression (Laminectomy, Laminotomy, Foraminotomy, and Discectomy).pdf
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Cohere Medical Policy - Spinal Cord Stimulators.pdf
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Cohere Medical Policy - Shoulder Arthroscopy.pdf
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Cohere Medical Policy - Shoulder Arthroplasty.pdf
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Cohere Medical Policy - Sacroiliac Joint Injections and Radiofrequency Ablation (RFA).pdf
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Cohere Medical Policy - Sacroiliac (SI) Joint Fusion.pdf
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Cohere Medical Policy - Pediatric Vertebral Body Tethering .pdf
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Cohere Medical Policy - Lumbar or Thoracic Spinal Fusion.pdf
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Cohere Medical Policy - Kyphoplasty and Vertebroplasty.pdf
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Cohere Medical Policy - Kyphectomy.pdf
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Cohere Medical Policy - Knee Arthroscopy.pdf
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Cohere Medical Policy - Knee Arthroplasty.pdf
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Cohere Medical Policy - Intrathecal Pain Pumps.pdf
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Cohere Medical Policy - Intradiscal Biacuplasty, PIRFT, or IDET.pdf
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Cohere Medical Policy - Interspinous Process Devices without Open Decompression.pdf
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Cohere Medical Policy - Interspinous Process Devices with Open Decompression.pdf
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Cohere Medical Policy - Interphalangeal Joint Arthroplasty.pdf
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Cohere Medical Policy - Internal Loop Recorders.pdf
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Cohere Medical Policy - Hip Arthroscopy (2).pdf
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Cohere Medical Policy - Hip Arthroplasty (Partial, Total, or Revision).pdf
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Cohere Medical Policy - Hammertoe, Claw Toe, or Mallet Toe Surgical Treatment With or Without Fusion.pdf
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Cohere Medical Policy - Great Toe Surgical Treatments.pdf
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Cohere Medical Policy - Genicular Nerve Procedures.pdf
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Cohere Medical Policy - Facet Joint Radiofrequency Ablation (RFA).pdf
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Cohere Medical Policy - Facet Injections.pdf
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Cohere Medical Policy - Epidural Steroid Injections (ESIs).pdf
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Cohere Medical Policy - Cervical Spinal Fusion.pdf
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Cohere Medical Policy - Bunionette Surgical Treatments.pdf
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Cohere Medical Policy - Bone Xenograft.pdf
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Cohere Medical Policy - Ankle Arthroplasty.pdf
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Cohere Medical Policy - Ankle Arthrodesis .pdf
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Cohere Medical Policy - Tarsometatarsal Arthrodesis.pdf
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Right Heart Catheterization and_or Left Ventriculogram Guideline.pdf
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Left and Right Heart Catheterization Guideline.pdf
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Cohere Medical Policy - Transcatheter Mitral Valve Repair.pdf
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Cohere Medical Policy - Transcatheter Aortic Valve Replacement_Implantation (TAVR_TAVI).pdf
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Cohere Medical Policy - PFO, ASD Closure.pdf
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Cohere Medical Policy - Percutaneous Coronary Intervention.pdf
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Cohere Medical Policy - Lower Extremity Arterial Revascularization (1).pdf
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Cohere Medical Policy - Left Heart Catheterization .pdf
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Cohere Medical Policy - Left Atrial Appendage Implants.pdf
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Cohere Medical Policy - Leadless Cardiac Pacemakers.pdf
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Cohere Medical Policy - Implantable Pulmonary Artery Pressure Sensors (IPAPS) for Heart Failure Management (1).pdf
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Cohere Medical Policy - External Cardiac Monitoring Devices.pdf
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Cohere Medical Policy - Electrophysiological Study (EPS).pdf
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Cohere Medical Policy - Descending Thoracic and Abdominal Aortic Aneurysm Repair.pdf
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Cohere Medical Policy - Coronary Atherectomy.pdf
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Cohere Medical Policy - Catheter-Based Angiogram, Lower Extremity Arteries.pdf
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Cohere Medical Policy - Carotid Endarterectomy (CEA).pdf
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Cohere Medical Policy - Carotid Artery Stenting (CAS) and_or Transcarotid Artery Revascularization (TCAR).pdf
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Cohere Medical Policy - Cardiac Implantable Rhythm Management Devices.pdf
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Cohere Medical Policy - Cardiac Catheterization.pdf
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Cohere Medical Policy - Cardiac Ablation.pdf
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Site of Service Criteria for Inpatient vs. Outpatient Services .pdf
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Cohere Medical Policy - Positron Emission Tomography (PET), PET_Computed Tomography (CT).pdf
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Cohere Medical Policy - Positron Emission Tomography (PET), Brain.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Upper Extremity.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Temporomandibular Joint (TMJ).pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Spine.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Pelvis.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Neck_Orbit_Face.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Lower Extremity.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Chest.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Brain.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Brain Functional.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Bone Marrow.pdf
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Cohere Medical Policy - Magnetic Resonance Imaging (MRI), Abdomen and Magnetic Resonance Cholangiopancreatography (MRCP).pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Upper Extremity .pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Spinal Canal.pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Neck.pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Lower Extremity.pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Head.pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Chest.pdf
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Cohere Medical Policy - Magnetic Resonance Angiography (MRA), Abdomen_Pelvis.pdf
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Cohere Medical Policy - Magnetic Resonance (MR) Spectroscopy.pdf
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Cohere Medical Policy - Magnetic Resonance (MR) Elastography.pdf
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Cohere Medical Policy - Computed Tomography Angiography (CTA), Upper Extremity.pdf
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Cohere Medical Policy - Computed Tomography Angiography (CTA), Lower Extremity.pdf
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Cohere Medical Policy - Computed Tomography Angiography (CTA), Head and Neck.pdf
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Cohere Medical Policy - Computed Tomography Angiography (CTA), Abdomen_Pelvis.pdf
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Cohere Medical Policy - Computed Tomography (CT), Upper Extremity .pdf
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Cohere Medical Policy - Computed Tomography (CT), Spine (Cervical, Thoracic, and Lumbar).pdf
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Cohere Medical Policy - Computed Tomography (CT), Orbit_Ear_Sella.pdf
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Cohere Medical Policy - Computed Tomography (CT), Neck (Soft Tissue).pdf
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Cohere Medical Policy - Computed Tomography (CT), Lower Extremity.pdf
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Cohere Medical Policy - Computed Tomography (CT), Face_Sinus.pdf
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Cohere Medical Policy - Computed Tomography (CT), Colonography.pdf
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Cohere Medical Policy - Computed Tomography (CT), Chest.pdf
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Cohere Medical Policy - Computed Tomography (CT), Cerebral Perfusion Analysis.pdf
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Cohere Medical Policy - Computed Tomography (CT), Brain.pdf
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Cohere Medical Policy - Computed Tomography (CT), Abdomen_Pelvis.pdf
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Cohere Medicare Advantage Policy - Xenograft Implantation.pdf
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Cohere Medicare Advantage Policy - Vertebral Corpectomy.pdf
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Cohere Medicare Advantage Policy - Vertebral Body Tethering.pdf
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Cohere Medicare Advantage Policy - Total Disc Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Thoracolumbar Spinal Fusion with or without Pelvic Fixation.pdf
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Cohere Medicare Advantage Policy - Thermal Ablation of the Intraosseous Basivertebral Nerve (BVN).pdf
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Cohere Medicare Advantage Policy - Tarsometatarsal Arthrodesis.pdf
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Cohere Medicare Advantage Policy - Subchondroplasty.pdf
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Cohere Medicare Advantage Policy - Spinal Decompression (Laminectomy, Laminotomy, Foraminotomy, and Discectomy).pdf
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Cohere Medicare Advantage Policy - Spinal Cord Stimulators .pdf
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Cohere Medicare Advantage Policy - Shoulder Arthroscopy.pdf
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Cohere Medicare Advantage Policy - Shoulder Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Sacroiliac Joint Injections and Radiofrequency Ablation (RFA).pdf
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Cohere Medicare Advantage Policy - Sacroiliac Joint Fusion (3).pdf
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Cohere Medicare Advantage Policy - Pediatric Vertebral Body Tethering (VBT) and Vertical Expandable Prosthetic Titanium Rib (VEPTR) .pdf
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Cohere Medicare Advantage Policy - Lumbar Spinal Fusion.pdf
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Cohere Medicare Advantage Policy - Kyphoplasty and Vertebroplasty .pdf
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Cohere Medicare Advantage Policy - Kyphectomy.pdf
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Cohere Medicare Advantage Policy - Knee Arthroscopy.pdf
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Cohere Medicare Advantage Policy - Knee Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Intrathecal Pain Pumps.pdf
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Cohere Medicare Advantage Policy - Interspinous Process Devices without Decompression.pdf
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Cohere Medicare Advantage Policy - Interspinous Process Devices with Open Decompression.pdf
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Cohere Medicare Advantage Policy - Interphalangeal Joint Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Hip Arthroscopy.pdf
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Cohere Medicare Advantage Policy - Hip Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Hammertoe, Claw Toe, or Mallet Toe Surgical Treatment With or Without Fusion.pdf
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Cohere Medicare Advantage Policy - Great Toe Surgical Treatments.pdf
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Cohere Medicare Advantage Policy - Genicular Nerve Procedures .pdf
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Cohere Medicare Advantage Policy - Cervical Spinal Fusion.pdf
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Cohere Medicare Advantage Policy - Bunionette Surgical Treatments.pdf
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Cohere Medicare Advantage Policy - Ankle Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Ankle Arthrodesis.pdf
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Cohere Medicare Advantage Policy - Right Heart Catheterization and_or Left Ventriculogram.pdf
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Cohere Medicare Advantage Policy - Positron Emission Tomography (PET), PET_Computed Tomography (CT).pdf
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Cohere Medicare Advantage Policy - Percutaneous Coronary Intervention_Angioplasty_Stent.pdf
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Cohere Medicare Advantage Policy - Patent Foramen Ovale (PFO) and Atrial Septal Defect (ASD) Closure.pdf
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Cohere Medicare Advantage Policy - MRI Abdomen and MRCP.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Upper Extremity.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Temporomandibular Joint (TMJ).pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Spine (Cervical and Thoracic).pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Pelvis.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Neck_Orbit_Face .pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Lumbar Spine.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Lower Extremity .pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Chest .pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Brain.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Brain Functional.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Bone Marrow.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Upper Extremity.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Neck.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Lower Extremity.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Head.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Chest.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Abdomen_Pelvis.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA) Spinal Canal.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance (MR) Spectroscopy.pdf
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Cohere Medicare Advantage Policy - Magnetic Resonance (MR) Elastography .pdf
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Cohere Medicare Advantage Policy - Lower Extremity Arterial Revascularization.pdf
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Cohere Medicare Advantage Policy - Left Heart Catheterization (Coronary Angiography and_or Bypass Angiography).pdf
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Cohere Medicare Advantage Policy - Left and Right Heart Catheterization .pdf
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Cohere Medicare Advantage Policy - Leadless Cardiac Pacemakers.pdf
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Cohere Medicare Advantage Policy - Internal Loop Recorders.pdf
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Cohere Medicare Advantage Policy - External Cardiac Monitoring Devices.pdf
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Cohere Medicare Advantage Policy - Electrophysiological Study (EPS).pdf
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Cohere Medicare Advantage Policy - Descending Thoracic and Abdominal Aortic Repair.pdf
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Cohere Medicare Advantage Policy - CT Lower Extremity.pdf
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Cohere Medicare Advantage Policy - Coronary Artery Atherectomy.pdf
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Cohere Medicare Advantage Policy - Computed Tomography Angiography (CTA), Upper Extremity.pdf
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Cohere Medicare Advantage Policy - Computed Tomography Angiography (CTA), Head and Neck.pdf
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Cohere Medicare Advantage Policy - Computed Tomography Angiography (CTA), Chest.pdf
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Cohere Medicare Advantage Policy - Computed Tomography Angiography (CTA), Abdomen_Pelvis, Including Lower Extremity Runoff.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Upper Extremity.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Spine (Cervical, Thoracic, and Lumbar) .pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Orbit_Ear_Sella.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Neck (Soft Tissue).pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Face_Sinus.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Colonography.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Chest.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Cerebral Perfusion Analysis.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Brain.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Abdomen_Pelvis.pdf
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Cohere Medicare Advantage Policy - Catheter-Based Angiogram.pdf
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Cohere Medicare Advantage Policy - Carotid Endarterectomy (CEA) (1).pdf
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Cohere Medicare Advantage Policy - Carotid Artery Stenting (CAS) and_or Transcarotid Artery Revascularization (TCAR).pdf
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Cohere Medicare Advantage Policy - Carotid Artery Stenting (CAS) and_or Transcarotid Artery Revascularization (TCAR) without Distal Embolic Protection.pdf
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Cohere Medicare Advantage Policy - Cardiac Implantable Devices.pdf
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Cohere Medicare Advantage Policy - Cardiac Catheterization.pdf
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Cohere Medicare Advantage Policy - Cardiac Ablation.pdf
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Cohere Medicare Advantage Policy - Positron Emission Tomography (PET), Brain.pdf
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Cohere Medicare Advantage Policy- Spinal Cord Stimulators.pdf
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Cohere Medicare Advantage Policy - Kyphoplasty and Vertebroplasty.pdf
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Cohere Medicare Advantage Policy - Knee Arthroscopy.pdf
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Cohere Medicare Advantage Policy - Hip Arthroscopy.pdf
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Cohere Medicare Advantage Policy - Computed Tomography Angiography (CTA), Lower Extremity.pdf
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Cohere Medical Policy - Knee Arthroscopy .pdf
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Cohere Medical Policy - Hip Arthroscopy (1).pdf
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Cohere Medicare Advantage Policy - Vertebral Body Tethering.pdf
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Cohere Medicare Advantage Policy - Thoracolumbar Spinal Fusion with or without Pelvic Fixation.pdf
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Cohere Medicare Advantage Policy - Thermal Ablation of the Intraosseous Basivertebral Nerve (BVN).pdf
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Cohere Medicare Advantage Policy - Tarsometatarsal Arthrodesis.pdf
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Cohere Medicare Advantage Policy - Subchondroplasty.pdf
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Cohere Medicare Advantage Policy - Spinal Decompression (Laminectomy, Laminotomy, Foraminotomy, and Discectomy) (1).pdf
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Cohere Medicare Advantage Policy - Shoulder Arthroscopy.pdf
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Cohere Medicare Advantage Policy - Sacroiliac Joint Fusion .pdf
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Cohere Medicare Advantage Policy - Percutaneous Coronary Intervention (PCI).pdf
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Cohere Medicare Advantage Policy - Patent Foramen Ovale (PFO)_Atrial Septal Defect (ASD) Closure.pdf
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Cohere Medicare Advantage Policy - Lower Extremity Arterial Revascularization.pdf
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Cohere Medicare Advantage Policy - Kyphectomy (1).pdf
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Cohere Medicare Advantage Policy - Knee Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Interphalangeal Joint Arthroplasty.pdf
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Cohere Medicare Advantage Policy - Hammertoe, Claw Toe, or Mallet Toe Surgical Treatment With or Without Fusion.pdf
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Cohere Medicare Advantage Policy - Great Toe Surgical Treatments (1).pdf
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Cohere Medicare Advantage Policy - Genicular Nerve Procedures.pdf
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Cohere Medicare Advantage Policy - Computed Tomography (CT), Chest (1).pdf
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Cohere Medicare Advantage Policy - Bone Xenograft.pdf
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Cohere Medical Policy - Thoracolumbar Spinal Fusion With or Without Pelvic Fixation.pdf
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Cohere Medical Policy - Omnibus Codes (Musculoskeletal Care and Pain Management).pdf
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Cohere Medical Policy - Lower Extremity Arterial Revascularization.pdf
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Cohere Medical Policy - Knee Arthroplasty .pdf
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Cohere Medical Policy - Computed Tomography (CT), Chest .pdf
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