October 2026 Policy Updates

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

Policy #704: Nidra for Treatment of Restless Legs Syndrome (Effective Nov. 1, 2026)

On Nov. 1, 2026, Select Health will publish new medical policy #704 (Nidra for Treatment of Restless Legs Syndrome), which outlines non-coverage of this therapy.

Policy #698: Hyoid Suspension to Treat Obstructive Sleep Apnea (Effective Nov. 1, 2026)

The following exclusion will be added: "Select Health does not cover the mini-screw assisted rapid palatal expansion (MARPE) device as there is insufficient evidence to support long-term stability or efficacy; this meets the plan’s definition of experimental/investigational."

Policy #654: Peripheral Nerve Treatment (Effective Nov. 1, 2026)

The following exclusion will be added: "Select Health does not cover the Curonix PNS system for treatment of knee osteoarthritis as there is a lack of high-quality data to support its use for this indication; this meets the plan’s definition of experimental/investigational."

Policy #336: Stereotactic Radiation Therapy (Effective Nov. 1, 2026)

The following coverage will be added: "For members who are non-optimal candidates for surgery with stages T1a and T1b."

Policy #141: Kidney Transplant and Re-Transplantation (Effective Nov. 1, 2026)

Qualifying for approval of these procedures will be changed to when either recommended by an Optum Center of Excellence, or when the procedure meets InterQual guidelines.

Policy #185: Negative Pressure Wound Therapy (Effective Nov. 1, 2026)

Qualifying for approval of these procedures will be changed to when the procedure meets InterQual guidelines.

Policy #622: Cervical, Lumbar, and Thoracic Spinal Fusion with or without Spinal Decompression (Effective Nov. 1, 2026)

Qualifying for approval of these procedures will be changed to when the procedure meets InterQual guidelines.

Policy #463: Panniculectomy/Abdominoplasty

Responsibility for not-covered procedures will be shifted solely to members as these will be considered exclusively as cosmetic: "Select Health does NOT cover panniculectomy surgery for all other circumstances, as this is considered cosmetic in nature."

Policy #514: Whole Genomic Sequencing (WGS)/Whole Exome Sequencing (WES) (Effective Nov. 1, 2026)

The following exclusion will be added: "Select Health does not cover WGS/WES for solid tumor gene analysis as this has been determined to be experimental/investigational."

Policy #673: Genetic Testing: Minimal Residual Disease (MRD) Assessment (Effective Nov. 1, 2026)

An exclusion will be added for ctDNA tests when used for surveillance in Stage II colorectal cancer.

Policy #570: Genetic Testing: Genetic Mutation Analysis Utilizing Solid Tumor Tissue (Effective Nov. 1, 2026)

The following exclusion will be added: "Select Health does not cover WGS/WES for solid tumor gene analysis as this has been determined to be experimental/investigational."

Policy #185: Negative Pressure Wound Therapy (Effective Sep. 17, 2026)

Select Health-adopted Concert Lab policies as listed below (A4-A8), were updated to either Concert 2026.1 or 2026.2 versions:

• SH/LAB−A4 Infectious Disease Testing: Respiratory
• SH/LAB−A5 Infectious Disease Testing: Screening and Prevention
• SH/LAB−A6 Infectious Disease Testing: Vector-Borne
• SH/LAB−A7 Specialty Testing: Endocrinology
• SH/LAB−A8 Specialty Testing: Nutrition and Metabolism

And two new Select Health-adopted Concert lab policies were created (A10 and A11):

• SH/LAB-A10 Infectious Disease Testing: Dermatology
• SH/LAB-A11 Specialty Testing: Immunology and Rheumatology

Reminder for Appeals Documentation

As a reminder, please ensure that the documentation submitted is signed and that the same signed documentation accompanies any appeal.