April 2026 Policy Updates

Quick Overview

• Policy Updates
  • 1 new policy 
  • 11 revised medical policies
  • 1 archived policy
  • Additional announcements
• Coding Updates
  • New Coding Editing System Coming in April 2026
  • Use Correct Coding for Faster Claims Payment

*Changes apply ONLY to Commercial plan policy UNLESS summary text appears in bold.

A new policy, Hyoid Suspension to Treat Obstructive Sleep Apnea (#698), will be published on May 1, 2026. This policy will state the following:

"Select Health may cover hyoid suspension performed separately or combined, as it is considered effective when performed as part of the comprehensive surgical management of symptomatic adult patients with mild obstructive sleep apnea and adult patients with moderate and severe obstructive sleep apnea assessed as having tongue base or hypopharyngeal obstruction.

Select Health does not cover the AirLift procedure for hyoid suspension to treat obstructive sleep apnea as there is insufficient literature proving safety and efficacy; this meets the plan’s definition of experimental/investigational."

A new physical therapy/chiropractic therapy requirement will be implemented for the following policies:

• #622 — Cervical, Lumbar, and Thoracic Spinal Fusion with or without Spinal Decompression
• #557 — Radiofrequency Ablation of the Genicular Nerve
• #389 — Radiofrequency Ablation (RFA) of the Sacroiliac (SI) Joint
• #648 — Intracept
• #654 — Peripheral Nerve Stimulation
• #609 — Infusion Pumps
• #595 — Sacroiliac Joint Fusions
• #626 — Diagnostic and Therapeutic Interventions for Spinal Pain

The requirement will read as follows, with the updated portion in bold: "Minimum of 12 physical therapy visits or chiropractic visits within a 6-month period; must have been performed within the previous year (it is recommended that at least four of these visits be performed in-person). After 6 visits, additional therapy is not required if contraindicated or not recommended by the physical or chiropractic therapist.”

New Coding Editing System Coming in April 2026

Select Health will be transitioning to a new system that will better align our editing processes with standard coding practices and Select Health policies, ultimately improving edit consistency and accuracy. This new platform will launch on April 6, 2026. 

Use Correct Coding for Faster Claims Payment

To support accurate and timely claims payment, it is essential to follow correct coding practices. This includes:

• Selecting the appropriate modifiers
• Reporting the correct number of units
• Mapping each diagnosis code to the correct corresponding procedure code

The new editing system coming in 2026 will adhere to CMS requirements and established coding guidelines. Failure to comply with these standards may result in claim denials. By consistently applying these practices, we help ensure accurate claim processing and reduce the likelihood of denials or rework.