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Select Health Policies

Our policies determine what we consider standard medical practice, experimental/investigational, cosmetic, or within coding standards.

Medical Policies

Booklets organized by specialty practice.
See Policies

Medical Coding & Reimbursement

Individual Policies listed alphabetically.
See Policies

Dental Coding & Reimbursement

Individual policies listed in numerical order.
See Policies

Policy Bulletin & Archives

Latest policy updates and past information.
See Bulletins

Policy FAQs

Get specifics on policy guidelines and procedures. 

Select Health medical, dental, and coding/reimbursement policies represent our determination of whether services or devices are standard medical practice, experimental/investigational, cosmetic, or within coding standards. NOTE: By accessing and/or downloading Select Health policies, you automatically agree to the Medical and Coding/Reimbursement Policy Manual Terms and Conditions.

The above conclusions reflect our review of currently available clinical information including:

  • Research in peer-reviewed published medical literature
  • Regulatory status of the technology
  • Evidence-based guidelines of public health and health research agencies
  • Evidence-based guidelines and positions of leading national health professional organizations
  • Views of physicians practicing in relevant clinical areas
  • Other relevant factors

Coding & Reimbursement policies are based on a review of coding standards, including:

  • Centers for Medicare and Medicaid Services (CMS)
  • Current Procedural Terminology (CPT®)
  • Specialty societies (e.g., AAOS)
  • Other expert sources

Using the new policy search function is easy. See a video tutorial and supporting information here. 

  • View member pharmacy policies state by state and by drug here. 
  • Use PromptPA to obtain preauthorization for prescriptions and infusible drugs and to see pharmacy coverage requirements.
  • To submit a pharmacy-related appeal, please follow this simple process:
    • Step 1: Access the online appeals form.
    • Step 2: On the appeals form, be sure to select plan, fill in required fields, and attach supporting documentation (if necessary).
    • Step 3: Click the submit button at the bottom right of the form. 

Select Health uses InterQual coverage criteria when medical policy is not available. This information can be obtained by signing into the One Healthcare ID portal. 

View InterQual Login Instructions
Go to One Healthcare ID Portal

Gain access to MCG Criteria for care given to Select Health Medicare Nevada members. 

Laboratory utilization policies reflect a collaboration between Select Health and Concert. Learn more by accessing the frequently asked questions