Cohere Health Help Center

HealthPartners: Cohere Medicare Advantage & Commercial/Medicaid Policies

Written by Nicole Saidai

February 5, 2026

In this article, you can find Cohere guidelines for HealthPartners members with the following coverage:

Medicare Advantage (MA)
Commercial / Medicaid

Medicare Advantage (MA)	Medicare Advantage (MA)
Line of Business	Service
Medicare Advantage (MA)	Musculoskeletal Services Ankle Arthrodesis - Version 3 - Effective date 10/1/2025 Ankle Arthroplasty - Version 3 - Effective date 10/1/2025 Bunionette Surgical Treatments - Version 3 - Effective date 10/1/2025 Cervical Spinal Fusion - Version 3.1 - Effective date 10/1/2025 Genicular Nerve Procedures - Version 3 - Effective date 10/1/2025 Great Toe Surgical Treatments - Version 3 - Effective date 10/1/2025 Hammertoe, Claw Toe, or Mallet Toe Surgical Treatment with or without Fusion - Version 3 - Effective date 10/1/2025 Hip Arthroplasty - Version 3.1 - Effective date 10/1/2025 Hip Arthroscopy - Version 4 - effective date 1/1/2026 Interphalangeal Joint Arthroplasty - Version 3 - Effective date 10/1/2025 Interspinous Process Devices with Open Decompression - Version 3 - Effective date 10/1/2025 Interspinous Process Devices without Decompression - Version 3 - Effective date 10/1/2025 Intradiscal Biacuplasty, PIRFT, or IDET - Version 3.1 - Effective date 10/1/2025 Intrathecal Pain Pumps - Version 3 - Effective date 10/1/2025 Knee Arthroplasty - Version 4 - Effective date 10/1/2025 Knee Arthroscopy - Version 5 - effective date 1/1/2026 Kyphectomy - Version 3 - Effective date 10/1/2025 Kyphoplasty and Vertebroplasty - Version 1 - Effective date 10/1/2025 Lumbar Spinal Fusion - Effective date 8/1/2024 Pediatric Vertebral Body Tethering (VBT) and Vertical Expandable Prosthetic Titanium Rib (VEPTR) - Version 1 - Effective date 10/1/2025 Sacroiliac Joint Fusion - Version 3.2 - Effective date 10/1/2025 Sacroiliac Joint Injections and Radiofrequency Ablation - Version 2.1 - Effective date 10/1/2025 Shoulder Arthroplasty - Version 3 - Effective date 10/1/2025 Shoulder Arthroscopy - Version 3 - Effective date 10/1/2025 Spinal Cord Stimulators - Version 1.1 - Effective date 10/1/2025 Spinal Decompression - Version 4 Subchondroplasty - Version 3.1 - Effective date 10/1/2025 Tarsometatarsal Arthrodesis - Version 3 - Effective date 10/1/2025 Thermal Ablation of the Intraosseous Basivertebral Nerve - Version 3 - Effective date 10/1/2025 Thoracolumbar Spinal Fusion with or without Pelvic Fixation - Version 3 - Effective date 10/1/2025 Total Disc Arthroplasty - Version 3 - Effective date 10/1/2025 Vertebral Body Tethering - Version 3.1 - Effective date 10/1/2025 Vertebral Corpectomy - Version 3 - Effective date 10/1/2025 Xenograft Implantation - Version 3.1 - Effective date 10/1/2025
Medicare Advantage (MA)	Cardiovascular Services Cardiac Ablation - Version 3 - Effective date 10/1/2025 Cardiac Implantable Devices - Version 3 - Effective date 10/1/2025 Carotid Artery Stenting (CAS) and/or Transcarotid Artery Revascularization (TCAR) - Version 3 - Effective date 10/1/2025 Carotid Artery Stenting (CAS) and/or Transcarotid Artery Revascularization (TCAR) without Distal Embolic Protection - Effective date 8/1/2024 Cardiac Catheterization - Version 1 - Effective date 10/1/2025 Carotid Endarterectomy (CEA) - Version 1 - Effective date 10/1/2025 Catheter-based Angiogram (old title: Catheter-based Angiogram, Lower Extremity Arteries) - Version 3 - Effective date 10/1/2025 Coronary Artery Atherectomy - Version 3 - Effective date 10/1/2025 Descending Thoracic and Abdominal Aortic Repair - Version 3 - Effective date 10/1/2025 Electrophysiological Study (EPS) - Version 1 - Effective date 10/1/2025 Internal Loop Recorders - Version 1 - Effective date 10/1/2025 Leadless Cardiac Pacemakers - Version 3 - Effective date 10/1/2025 Left and Right Heart Catheterization - Effective date 8/1/2024 Left Heart Catheterization (Coronary Angiography and/or Bypass Angiography) - Effective date 8/1/2024 Lower Extremity Arterial Revascularization - Version 1.1 - effective 1/1/2026 Patent Foramen Ovale (PFO) and Atrial Septal Defect (ASD) Closure - Version 3 - Effective date 10/1/2025 Percutaneous Coronary Intervention/Angioplasty/Stent - Version 3 - Effective date 10/1/2025 Right Heart Catheterization and/or Left Ventriculogram - Effective date 8/1/2024
Medicare Advantage (MA)	Diagnostic Imaging Services Computed Tomography Angiography (CTA) CTA Abdomen/Pelvis, including Lower Extremity RunOff - Effective date 8/1/2025 Computed Tomography Angiography (CTA), Chest - Version 2 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Head - Version 2 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Lower Extremity - Version 2 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Neck - Version 2 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Upper Extremity - Version 2 - effective date 1/1/2026 Computed Tomography (CT) Computed Tomography (CT), Abdomen/Pelvis - Effective date 8/1/2025 Computed Tomography (CT), Brain - Effective date 8/1/2025 Computed Tomography (CT), Chest - Effective date 8/1/2025 Computed Tomography (CT), Colonography - Effective date 8/1/2025 Computed Tomography (CT), Face/Sinus - Effective date 8/1/2025 Computed Tomography (CT), Lower Extremity - Effective date 8/1/2025 Computed Tomography (CT), Neck (Soft Tissue) - version 2.1 - Effective date 8/1/2025 Computed Tomography (CT), Orbit/Ear/Sella - version 2.1 - Effective date 8/1/2025 Computed Tomography (CT), Spine (Cervical, Thoracic, and Lumbar) - version 2.1 - Effective date 8/1/2025 Computed Tomography (CT), Upper Extremity - Effective date 8/1/2025 Magnetic Resonance (MR) Magnetic Resonance (MR) Elastography - Effective date 8/1/2025 Magnetic Resonance (MR) Spectroscopy - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA) Magnetic Resonance Angiography (MRA), Abdomen/Pelvis - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA), Chest - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA), Head - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA), Lower Extremity - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA), Neck - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA), Spinal Canal - Effective date 8/1/2025 Magnetic Resonance Angiography (MRA), Upper Extremity - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI), Abdomen and Magnetic Resonance Cholangiopancreatography (MRCP) - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Bone Marrow - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Brain - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Brain Functional - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Chest - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Lower Extremity - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Neck/Orbit/Face - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Pelvis - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Spine (Cervical, Thoracic, and Lumbar) - version 1.1 - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Temporomandibular Joint (TMJ) - version 2.1 - Effective date 8/1/2025 Magnetic Resonance Imaging (MRI), Upper Extremity - Effective date 8/1/2025 Positron Emission Tomography (PET) Positron Emission Tomography (PET), Brain - Effective date 8/1/2025 Positron Emission Tomography (PET)/PET-Computed Tomography (CT) - Effective date 8/1/2025

Commercial / Medicaid	Commercial / Medicaid
Line of Business	Service
Commercial / Medicaid	Musculoskeletal Services Ankle Arthrodesis - Version 3 - effective date 1/1/2026 Bone Xenograft - Version 3 - Effective date 11/1/2025 Bunionette Surgical Treatments - Version 3 - Effective date 11/1/2025 Cervical Spinal Fusion - Effective date 6/1/2025 Epidural Steroid Injections (ESI) - Effective date 6/1/2025 Facet Injections - Effective date 6/1/2025 Facet Joint Radiofrequency Ablation (RFA) - Effective date 6/1/2025 Genicular Nerve Procedures - Version 3 - Effective date 11/1/2025 Great Toe Surgical Treatments - Version 3 - Effective date 11/1/2025 Hammertoe, Claw Toe, or Mallet Toe Surgical Treatment With or Without Fusion - Version 3 - Effective date 11/1/2025 Hip Arthroplasty (Partial, Total, or Revision) - Effective date 6/1/2025 Hip Arthroscopy - Version 5 - effective date 1/1/2026 Internal Loop Recorders - Effective date 6/1/2025 Interspinous Process Devices with Open Decompression - Effective date 2/1/2025 Interspinous Process Devices without Open Decompression - Effective date 6/1/2025 Interphalangeal Joint Arthroplasty - Version 3 - Effective date 11/1/2025 Intradiscal Biacuplasty, PIRFT, or IDET - Version 3 - Effective date 11/1/2025 Intrathecal Pain Pumps - Version 3 - Effective date 11/1/2025 Knee Arthroplasty - Version 6 - Effective date 10/1/2025 Knee Arthroscopy - Version 8 - effective date 1/1/2026 Kyphectomy - Effective date 6/1/2025 Kyphoplasty and Vertebroplasty - Version 3 - effective date 1/1/2026 Lumbar or Thoracic Spinal Fusion - Effective date 6/1/2025 Pediatric Vertebral Body Tethering - Effective date 11/1/2024 Sacroiliac Joint Injections and Radiofrequency Ablation (RFA) - Effective date 6/1/2025 Sacroiliac Joint Fusion - Effective date 6/1/2025 SI Joint Injections - Effective date 2/1/2025 Shoulder Arthroscopy - Version 5 - Effective date 10/1/2025 Shoulder Arthroplasty - Version 4 - Effective date 11/1/2025 Spinal Decompression - Version 4.1 - Effective date 1/20/2026 Subchondroplasty - Version 3 - Effective date 11/1/2025 Spinal Cord Stimulators - Effective date 6/1/2025 Tarsometatarsal Arthrodesis - Version 3 - Effective date 11/1/2025 Thermal Ablation of the Intraosseous Basivertebral Nerve (BVN) - Effective date 6/1/2025 Total Disc Arthroplasty - Effective date 6/1/2025 Vertebral Body Tethering - Version 3 - Effective date 11/1/2025 Vertebral Corpectomy - Effective date 6/1/2025
Commercial / Medicaid	Cardiovascular Services Cardiac Ablation - Effective date 6/1/2025 Cardiac Catheterization - Version 1 - Effective date 10/1/2025 Cardiac Implantable Devices - Effective date 6/1/2025 Carotid Artery Stenting (CAS) and/or Transcarotid Artery Revascularization (TCAR) - Version 2 - Effective date 11/1/2025 Carotid Endarterectomy (CEA) - Version 2 - Effective date 11/1/2025 Catheter-Based Angiogram, Lower Extremity Arteries - Version 3 - effective date 1/1/2026 Coronary Atherectomy - Effective date 6/1/2025 Descending and Abdominal Aortic Aneurysm Repair - Version 2 - Effective date 11/1/2025 Electrophysiological Study (EPS) - Version 2 - Effective date 11/1/2025 External Wearable Devices - Version 4 - Effective date 6/1/2025 Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management (IPAPS) - Version 4 Leadless Cardiac Pacemakers - Effective date 6/1/2025 Left and Right Heart Catheterization - Effective date 8/1/2024 Left Atrial Appendage Implants - Effective date 6/1/2025 Left Heart Catheterization - Effective date 6/1/2025 Lower Extremity Arterial Revascularization - Version 3.1 - effective 1/1/2026 Percutaneous Coronary Intervention (PCI)/Angioplasty/Stent - Effective date 6/1/2025 Patent Foramen Ovale (PFO) and Atrial Septal Defect (ASD) Closure - Version 2 - Effective date 11/1/2025 Right Heart Catheterization and/or Left Ventriculogram - Effective date 8/1/2024 Transcatheter Aortic Valve Replacement/Implantation (TAVR/TAVI) - Version 3 - effective date 1/1/2026 Transcatheter Mitral Valve Repair - Version 2 - Effective date 11/1/2025
Commercial / Medicaid	Diagnostic Imaging Services Magnetic Resonance (MR) Magnetic Resonance (MR) Spectroscopy - Version 3 - effective date 1/1/2026 Magnetic Resonance (MR) Elastography - Version 3 - effective date 1/1/2026 Computed Tomography (CT) Computed Tomography (CT), Abdomen Pelvis - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Brain - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Chest - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Colonography - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Face Sinus - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Neck (Soft Tissue) - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Orbit Ear Sella - Version 4 - effective date 1/1/2026 Computed Tomography (CT), Lower Extremity - Version 5 - effective date 1/1/2026 Computed Tomography (CT), Spine (Cervical, Thoracic, and Lumbar) - Version 5 - effective date 1/1/2026 Computed Tomography (CT), Upper Extremity - Version 5 - effective date 1/1/2026 Computed Tomography Angiography (CTA) Computed Tomography Angiography (CTA), Abdomen Pelvis - Version 4 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Head - Version 4 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Lower Extremity - Version 4 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Neck - Version 4 - effective date 1/1/2026 Computed Tomography Angiography (CTA), Upper Extremity - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA) Magnetic Resonance Angiography (MRA), Abdomen Pelvis - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA), Chest - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA), Head - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA), Lower Extremity - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA), Neck - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA), Spinal Canal - Version 4 - effective date 1/1/2026 Magnetic Resonance Angiography (MRA), Upper Extremity - Version 4 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI), Brain Functional - Version 4 - Effective date 11/1/2025 Magnetic Resonance Imaging (MRI), Abdomen and Magnetic Resonance Cholangiopancreatography (MRCP) - Version 4 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Brain - Version 4 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Bone Marrow - Version 5 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Chest - Version 4 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Lower Extremity - Version 5 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Neck/Orbit/Face - Version 4 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Pelvis - Version 3 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Spine - Version 5 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Temporomandibular Joint (TMJ) - Version 4 - effective date 1/1/2026 Magnetic Resonance Imaging (MRI), Upper Extremity - Version 5 - effective date 1/1/2026 Positron Emission Tomography (PET) Positron Emission Tomography (PET), Brain - Version 4 - effective date 1/1/2026 Positron Emission Tomography (PET)/Computed Tomography (CT) - Version 6 - effective date 1/1/2026
Commercial / Medicaid	Site of Service Criteria Site of Service Criteria for Inpatient vs. Outpatient Services- Effective date 8/1/2024 For provider reference only, not used for decisioning Does not apply to Medicare

Upcoming Policy Changes	Upcoming Policy Changes
Line of Business	Service
Medicare Advantage (MA)	Diagnostic Imaging Effective 2/1/2026 Computed Tomography (CT) Computed Tomography (CT), Brain - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Colonography - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Face/Sinus - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Lower Extremity - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Neck (Soft Tissue) - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Orbit/Ear/Sella - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Spine (Cervical, Thoracic, and Lumbar) - Version 2 - effective date 2/1/2026 Computed Tomography (CT), Upper Extremity - Version 2 - effective date 2/1/2026 Computed Tomography Angiography (CTA) Computed Tomography Angiography (CTA), Abdomen_Pelvis, including Lower Extremity Runoff - effective date 2/1/2026 Magnetic Resonance Magnetic Resonance Spectroscopy - Version 2 - effective date 2/1/2026 Magnetic Resonance Angiography (MRA) Magnetic Resonance Angiography (MRA), Upper Extremity - Version 2 - effective date 2/1/2026 Magnetic Resonance Angiography (MRA), Abdomen/Pelvis - Version 2 - effective date 2/1/2026 Magnetic Resonance Angiography (MRA), Chest - Version 2 - effective date 2/1/2026 Magnetic Resonance Angiography (MRA), Lower Extremity - Version 2 - effective date 2/1/2026 Magnetic Resonance Angiography (MRA), Spinal Canal - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI), Abdomen and Magnetic Resonance Cholangiopancreatography (MRCP) - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Chest - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Bone Marrow - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Brain - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Brain Functional - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Lower Extremity - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Neck/Orbit/Face - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Pelvis - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Spine (Cervical, Thoracic) - Version 2 - effective date 2/1/2026 Magnetic Resonance Imaging (MRI), Temporomandibular Joint (TMJ) - Version 2 - effective date 2/1/2026 Magnetic Resonance imaging (MRI), Upper Extremity - version 2 - effective date 2/1/2026 Positron Emission Tomography (PET) Positron Emission Tomography (PET), Brain - Version 2 - effective date 2/1/2026 Positron Emission Tomography (PET)/PET-Computed Tomography (CT) - Version 2 - effective date 2/1/2026 Effective 4/1/2026 Cohere Medicare Advantage Policy - Computed Tomography (CT), Abdomen_Pelvis - Version 2 - effective date 4/1/2026 Cohere Medicare Advantage Policy - Computed Tomography (CT), Chest - Version 2 - effective date 4/1/2026 Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Head - Version 2 - effective date 4/1/2026 Cohere Medicare Advantage Policy - Magnetic Resonance Angiography (MRA), Neck - Version 2 - effective date 4/1/2026 Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Lumbar Spine - Version 1 - effective date 4/1/2026 Cohere Medicare Advantage Policy - Magnetic Resonance Imaging (MRI), Upper Extremity - Version 2 - effective date 4/1/2026 Musculoskeletal Effective 4/1/2026 Cohere Medicare Advantage Policy - Knee Arthroscopy - Version 6 - effective date 4/1/2026 Cohere Medicare Advantage Policy - Total Disc Arthroplasty - Version 4 - effective date 4/1/2026
Commercial	Musculoskeletal Effective 4/1/2026 Cohere Medical Policy - Knee Arthroscopy - Version 9 - effective date 4/1/2026 Cohere Medical Policy - Sacroiliac Joint (SIJ) Injections and Radiofrequency Ablation (RFA) - Version 5 - effective date 4/1/2026

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