Cohere Health’s Scope of Management
HealthPartners, Cardiovascular and Musculoskeletal Services
Overview
Cohere Health, a patient journey optimization company, is designated the exclusive preauthorization and utilization management vendor for some cardiology and musculoskeletal services. Effective August 1, 2024, Cohere will manage prior authorization requests for the specific services listed below.
Impacted Plans and Geographies
These changes apply to all fully insured commercial plans, Medicare plans and Minnesota Health Care Programs (Medicaid plans) including MSHO. Prior authorization will not be required for Self-insured plans. Cohere Health coverage criteria will be utilized. For Medicare plans, Cohere utilizes National coverage determinations (NCDs) and/or local coverage determinations (LCDs) from the Centers for Medicare and Medicaid Services (CMS). Cohere criteria will be utilized as secondary criteria when CMS guidance is absent or not fully established.
Clinical Scope
Practices must use Cohere when requesting preauthorization for any of the procedure codes or services listed in the table below.
For more information and to view the official and most up to date HealthPartners Preauthorization List (PAL), please visit healthpartners.com
Use Cohere to obtain preauthorizations for the following procedure codes:
Cardiology | Cardiology |
Service Category | Procedure Codes (HCPCS) |
Ablation | 93650, 93653, 93654, 93656 |
Cath | 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93593, 93594, 93595, 93596, 93597 |
Cardiac Devices | 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33216, 33217, 33221, 33224, 33227, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33240, 33241, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, 33274, 33275, 33285, 33286, 33289, 33340, 33361, 33362, 33363, 33364, 33365, 33366, 33418, 93228, 93229, 93580, 0345T, 0571T, 0572T, 0573T, 0574T, 0580T, 0614T, C1721, C1722, C1777, C1779, C1785, C1786, C1882, C1895, C1896, C1898, C1899, C1900, C2619, C2620, C2621, C2624 |
EPS | 93600, 93602, 93603, 93610, 93612, 93618, 93619, 93620, 93624, 93631, 93640, 93641, 93642, 93644, 0577T |
Interventions | 33875, 33877, 33880, 33881, 33883, 33886, 34701, 34702, 34703, 34704, 34705, 34706, 34830, 34831, 34832, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848, 35301, 36245, 36246, 36247, 37215, 37216, 37217, 37218, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 0505T |
PCI | 92924, 92933, C9602, 92920, 92928, 92937, 92943, C9600, C9604, C9607 |
Musculoskeletal (MSK) | Musculoskeletal (MSK) |
Service Category | Procedure Codes (HCPCS) |
Arthroplasty | 23472, 23473, 23474, 27125, 27130, 27132, 27134, 27137, 27138, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487 |
Arthroscopy | 23929, 27299, 27412, 27599, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29850, 29851, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29914, 29915, 29916, 29999, 0707T, 0737T, C9781, J7330, S2112, S2300 |
ESI | 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484 |
Facet | 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T |
Foot Surgery | 26535, 26536, 28110, 28240, 28285, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 28306, 28308, 28310, 28740, 28750, L8641 |
Miscellaneous | 27700, 27702, 27870, 64454, 64624, 64625 |
Pain Infusion Pump | 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362, C1772, C1891, C2626, E0782, E0783, E0785, E0786 |
SI Injections | 27096 |
Spinal Cord Stim | 63650, 63655, 63663, 63664, 63685, 63688, C1816, C1820, C1822, L8679, L8680, L8682, L8685, L8686, L8687, L8688 |
Spine Surgery | 20999, 22100, 22101, 22102, 22103, 22116, 22510, 22511, 22512, 22513, 22514, 22515, 22526, 22527, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22586, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22856, 22857, 22858, 22859, 22861, 22862, 22867, 22868, 22869, 22870, 22899, 27279, 27280, 62287, 62380, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63273, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 63295, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 64628, 64629, 0095T, 0098T, 0164T, 0165T, 0202T, 0219T, 0220T, 0221T, 0222T, 0274T, 0275T, 0656T, 0657T, C1821, C2614, C9757, S2348, S2350, S2351 |
Please note that issuance of an approval decision for any preauthorization request does not represent a guarantee of payment. Always refer to HealthPartners official Preauthorization Lists (PAL) at healthpartners.com (Path: Provider/Coverage Criteria) for the most up to date preauthorization requirements, coverage policies, and related plan policies.