Quick Overview
- Policy Updates
- Coding Updates
- Genetics Tests that Require Preauthorization
Policy Bulletin
May 2026 Policy Updates
New Policies
Category
Policy Title (Number)
Date
Summary of Change
Physical Medicine
4/2/2026
Created and published this new medical policy: "Select Health does not cover low-dose radiation therapy for arthritis. The long-term safety and efficacy of this treatment have not been established; this meets the plan’s definition of experimental/investigational."
Revised Policies
*Changes apply ONLY to Commercial plan policy UNLESS summary text appears in bold.
Category
Policy Title (Number)
Date
Summary of Change
Durable Medical Equipment
4/16/2026
Added “Severe thrombocytopenia” to coverage criteria as a qualifying factor for classification of high bleeding risk.
General Surgery
4/2/2026
Clarified requirements in new criteria sections A. (Radiofrequency Ablation), B. (Liquid or Foam Sclerotherapy), and C. (Ambulatory Phlebectomy or Transilluminated Powered Phlebectomy).
Genetic Testing
4/3/2026
Added new criterion A, 4v: “Short stature” and added clarification to criterion B, 1ii: “Fetal demise or stillbirth occurred at 20 weeks of gestation or later (based on last menstrual period or first trimester ultrasound dating).”
Genetic Testing
3/26/2026
Modified title of policy to incorporate exclusion of genetic testing for any type of dementia, “Genetic Testing for Dementia and Apolipoprotein (APOE) Testing.”
Genetic Testing
4/9/2026
Added the following clarification to header of section C: “WGS/WES is allowed for fetal testing during pregnancy …”; and added both of the following exclusions: “WGS/WES is considered experimental/investigational for pregnancy loss/stillbirth.” and “Select Health will not reimburse any additional charges for long-read sequencing, as long-read sequencing has been determined to be experimental/investigational.”
Genetic Testing
3/23/2026
Added exclusion of the ArteraAI test.
Genitourinary
4/22/2026
Removed previous criterion #2 concerning requirement of completion of a cystoscopy in Urinary section.
Hematology/Oncology
4/10/2026
Modified coverage criteria as follows: “Select Health covers transcatheter arterial embolization (TACE) when either A or B are met: A. Approved if recommended and performed by Intermountain Interventional Radiology; OR B. For all other clinicians, Select Health covers these procedures when appropriate InterQual subset guidelines are met: Ablative or Transarterial Therapy, Liver.”
Women's Health
4/3/2026
Added new criteria section B for consideration of coverage: “For individuals with a diagnosis of unilateral breast cancer undergoing mastectomy for a primary malignancy, when contralateral prophylactic mastectomy is done for symmetry purposes with no plans for future breast reconstruction.”
Archived Policies
Category
Policy Title (Number)
Date
Summary of Change
N/A
Testing Serum Vitamin D Levels Policy
Policy #CR-77
4/10/2026
Archived policy; New edits are now used to manage review of codes listed in this policy.
Additional Announcements
The following instructions for accessing InterQual criteria have been added to the Policies home page to aid providers who may need InterQual criteria for obtaining information regarding applicable prior authorization requirement:
New Genetic Testing Policies
Effective June 1, 2026, Select Health will be incorporating and publishing Concert-adopted genetic testing criteria into 25 new policies to coincide with existing laboratory-related policies adopted from Concert by Select Health last November.
Policy Number
Policy Name
SH/GENETICS-A1
Genetic Testing: Specialty - Cardiovascular
SH/GENETICS-A2
Genetic Testing: Specialty - Dermatology
SH/GENETICS-A3
Genetic Testing: Specialty - Gastroenterology
SH/GENETICS-A4
Genetic Testing: Specialty - Hematology
SH/GENETICS-A5
Genetic Testing: Specialty - Identity and Forensics
SH/GENETICS-A6
Genetic Testing: Specialty - Immunology and Rheumatology
SH/GENETICS-A7
Genetic Testing: Specialty - Multisystem Genetic Conditions
SH/GENETICS-A8
Genetic Testing: Specialty - Nephrology
SH/GENETICS-A9
Genetic Testing: Specialty - Neurology
SH/GENETICS-A10
Genetic Testing: Specialty - Nutrition and Metabolism
SH/GENETICS-A11
Genetic Testing: Specialty - Ophthalmology
SH/GENETICS-A12
Genetic Testing: Specialty - Orthopedics
SH/GENETICS-A13
Genetic Testing: Specialty - Otolaryngology
SH/GENETICS-A14
Genetic Testing: Specialty - Respiratory
SH/GENETICS-A15
Genetic Testing: Specialty - Toxicology and Pharmacogenomics
SH/GENETICS-A16
Genetic Testing: Specialty - Transplant
SH/GENETICS-A17
Genetic Testing: Oncology - Algorithmic Assays
SH/GENETICS-A18
Genetic Testing: Oncology - Cancer Screening and Surveillance
SH/GENETICS-A19
Genetic Testing: Oncology - Hereditary Cancer
SH/GENETICS-A20
Genetic Testing: Oncology - Solid Tumor Molecular Diagnostics
SH/GENETICS-A21
Genetic Testing: Reproductive - Carrier Screening
SH/GENETICS-A22
Genetic Testing: Reproductive - Prenatal Diagnosis
SH/GENETICS-A23
Genetic Testing: Routine - General Approach to Laboratory Testing
Coding Updates
Genetics Tests that Require Preauthorization
We’re seeing an increase in claim denials for genetic testing services when preauthorization is not obtained. As a reminder, some genetic tests do require preauthorization. Please refer to the Preauth & Care Plan Tool page for the complete list of codes that require preauth.
