Quick Overview
Policy Updates
- Modifier Reminders for All Lines of Business
- Reminder for Codes 88300-88399
Policy Bulletin
August 2026 Policy Updates
Revised Policies
*Changes apply ONLY to Commercial plan policy UNLESS summary text appears in bold.
Category
Policy Title (Number)
Date
Summary of Change
General Surgery
7/16/2026
For Commercial Plan Policy, removed “and phlebectomy” from introductory paragraph in section D for clarification.
Obstetrics/ Gynecology
6/30/2026
For Commercial Plan Policy, added transcervical radiofrequency ablation as a qualifying treatment option when coverage criteria are met.
Oral Maxillofacial
6/25/2026
For Commercial Plan Policy, modified requirements outlined in criterion #1-D: “Asymmetries: anteroposterior, transverse, or lateral asymmetries of 3 mm or greater, with concomitant occlusal asymmetry.”
Physical Medicine
7/17/2026
For Commercial Plan Policy, removed the following limitation previously listed in the policy: “The procedure may not be repeated for five years after the initial procedure.”; and added the following clarifying footnote to criterion #3: “Differentiating between facet joint pain and discogenic pain (pain originating from an intervertebral disc) comes down to what makes the pain better or worse. Facet pain is typically aggravated by bending backward and twisting, while disc pain worsens with bending forward and sitting.”
Additional Announcements
- For medical policy #673 (Genetic Testing: Minimal Residual Disease Assessment), effective September 1, 2026, Select Health will cover ctDNA tests (e.g., Natera Signatera test) for surveillance and molecular residual disease monitoring for Stage II (T3-T4) colorectal cancer that is node-negative and has no metastasis when the member meets the following criteria:
- Must have undergone surgery within the last month
- Is being considered for adjuvant chemotherapy
- Has no radiographic evidence of disease
- For medical policy #514 (Whole Genomic Sequencing [WGS]/Whole Exome Sequencing [WES]), effective September 1, 2026, the following exclusion will be implemented: "Select Health does not cover exome-to-genome reflex tests as it is considered not medically necessary to perform WES before WGS."
- Effective September 1, 2026, Select Health will publish new medical policy #703 (ROMTech), which will outline exclusion of this technology/procedure: "Select Health does not cover services associated with The ROMTech PortableConnect system as the use of rehabilitative devices with remote monitoring or adjustment capabilities is considered not medically necessary."
- Medical policy #580 (Corneal Crosslinking) will be archived on September 1, 2026; starting on this same date, all requests pertaining to coverage of this treatment should be submitted through Select Health Pharmacy.
Coding Updates
Modifier Reminders for all Lines of Business
- We have seen an increase in claims submitted with modifier 26 appended to laboratory procedure codes. Modifier 26 is not applicable to most laboratory services and may result in claim denials or processing delays. To support accurate claim adjudication and timely reimbursement, please ensure that modifiers are billed only when appropriate and in accordance with coding guidelines.
- We require the appropriate modifier on E&M codes when billed with procedures that have a global even if there is not an NCCI edit.
- Select Health will only allow CPT 93010 when billed with an evaluation and management (E&M) service if the E&M is billed with modifier 25.
Reminder for Codes 88300-88399
Select Health only allows practitioners to bill the interpretation and report for codes 88300-88399. If a practitioner bills 88300-88399 as a global service, it will be subject to clinical editing.