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PrimeWest Health policies

Search PrimeWest Health's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

141 public policies Substrate tracks for PrimeWest Health, by title.

PrimeWest Health policies
PolicyDetailsCodesSource
AuthorizationMedicaid · MN—Original policy ↗
Authorization > Authorization CriteriaPW_03-19_102 · Effective Feb 6, 2020 · Medicaid · MN—Original policy ↗
Authorization > Direct Access ServicesPW_03-19_104 · Effective Jan 20, 2023 · Medicaid · MN—Original policy ↗
Authorization > Out-of-Network ProvidersPW_03-19_103 · Effective Dec 3, 2021 · Medicaid · MN—Original policy ↗
Authorization > Physician and Professional Services Authorization StandardsMedicaid · MN57Original policy ↗
Authorization > Service Authorization/Notification FormsPW_03-19_107 · Effective Oct 31, 2020 · Medicaid · MN—Original policy ↗
Authorization > Utilization ManagementPW_2011_255 · Effective Jan 16, 2026 · Medicaid · MN—Original policy ↗
Medical, Dental & PharmacyPW_12-16_508 · Effective Feb 15, 2017 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > DentalPW_2011_238 · Effective May 15, 2025 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Dental > BillingPW_11-18_441 · Effective Feb 5, 2026 · Medicaid · MN1Original policy ↗
Medical, Dental & Pharmacy > Dental > Billing > Critical Access Dental Payment ProgramPW_11-18_443 · Effective Nov 1, 2018 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Dental > Billing > Dental Procedures with Current CPT CodesPW_11-18_444 · Effective Nov 1, 2018 · Medicaid · MN2Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered ServicesMedicaid · MN269Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > Alveoloplasty/GingivectomyPW_11-18_438 · Effective Nov 1, 2018 · Medicaid · MN4Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > AnesthesiaPW_11-18_433 · Effective Nov 1, 2018 · Medicaid · MN2Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > Basic Screen SurveyPW_11-18_431 · Effective Sep 17, 2019 · Medicaid · MN1Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > Fluoride Varnish Application (FVA)PW_11-18_432 · Effective Feb 2, 2023 · Medicaid · MN2Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > Sleep Apnea AppliancePW_11-18_436 · Effective Nov 1, 2018 · Medicaid · MN2Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > TeledentistryPW_11-18_437 · Medicaid · MN18Original policy ↗
Medical, Dental & Pharmacy > Dental > Covered Services > Temporomandibular Joint Disorder (TMD)PW_11-18_439 · Effective Nov 1, 2018 · Medicaid · MN1Original policy ↗
Medical, Dental & Pharmacy > Dental > Non-Covered ServicesPW_11-18_440 · Effective Nov 1, 2018 · Medicaid · MN2Original policy ↗
Medical, Dental & Pharmacy > Dental > Submitting Dental Service Authorization RequestsPW_11-19_607 · Effective May 10, 2024 · Medicaid · MN2Original policy ↗
Medical, Dental & Pharmacy > MedicalPW_11-18_467 · Effective Nov 6, 2018 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Ambulatory Surgical ServicesPW_11-18_485 · Effective Nov 19, 2019 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Ambulatory Surgical Services > BillingPW_11-19_527 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Ambulatory Surgical Services > Covered ServicesPW_11-19_528 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Children's ServicesMedicaid · MN22Original policy ↗
Medical, Dental & Pharmacy > Medical > Children's Services > BillingMedicaid · MN11Original policy ↗
Medical, Dental & Pharmacy > Medical > Children's Services > ResourcesPW_11-19_530 · Effective Sep 10, 2026 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > ChiropracticPW_11-18_2018 · Effective Dec 16, 2025 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Chiropractic > BillingMedicaid · MN7Original policy ↗
Medical, Dental & Pharmacy > Medical > Chiropractic > Covered ServicesMedicaid · MN34Original policy ↗
Medical, Dental & Pharmacy > Medical > Chiropractic > Non-Covered ServicesPW_11-18_470 · Effective Jan 14, 2026 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic ServicesEffective Mar 7, 2023 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic Services > Community Health ClinicEffective Nov 27, 2024 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic Services > Community Health WorkerMedicaid · MN5Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic Services > FQHCPW_11-19_533 · Effective Dec 11, 2025 · Medicaid · MN5Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic Services > Health Care HomePW_11-19_534 · Effective Dec 16, 2025 · Medicaid · MN31Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic Services > PreventivePW_11-19_535 · Effective Nov 27, 2024 · Medicaid · MN14Original policy ↗
Medical, Dental & Pharmacy > Medical > Clinic Services > Public Health ClinicMedicaid · MN13Original policy ↗
Medical, Dental & Pharmacy > Medical > Community First Services and Supports (CFSS)Effective Oct 1, 2024 · Medicaid · MN1Original policy ↗
Medical, Dental & Pharmacy > Medical > Early Intensive Development and Behavioral Intervention (EIDBI)Medicaid · MN5Original policy ↗
Medical, Dental & Pharmacy > Medical > Equipment and SuppliesEffective Jan 1, 2018 · Medicaid · MN64Original policy ↗
Medical, Dental & Pharmacy > Medical > Equipment and Supplies > BillingMedicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Equipment and Supplies > Covered ServicesMedicaid · MN807Original policy ↗
Medical, Dental & Pharmacy > Medical > Equipment and Supplies > Documentation of OrdersMedicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > Equipment and Supplies > Non-Covered ServicesPW_11-19_539 · Effective Sep 8, 2025 · Medicaid · MN1Original policy ↗
Medical, Dental & Pharmacy > Medical > HCBSMedicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > HCBS > Authorization of ServicesPW_11-19_543 · Effective Jan 14, 2022 · Medicaid · MN—Original policy ↗
Medical, Dental & Pharmacy > Medical > HCBS > BillingMedicaid · MN—Original policy ↗

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Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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