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Policy Bulletin

November 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
Durable Medical Equipment
Bone Growth Stimulators: Ultrasound
Policy #201
10/1/2026
For Commercial Plan Policy, modified formatting of exclusions to ensure clarity: “Fractures that are open, or grade II or III, or unstable …”
Ophthalmology
Corneal Crosslinking for Treatment of Keratoconus
Policy #580
9/18/2026
For Commercial Plan Policy, modified overall criteria to align with guidelines utilized by Select Health Pharmacy for review of claims associated with corneal crosslinking; and included the following exclusion: “Select Health does NOT cover corneal crosslinking if the medication is denied by Select Health Pharmacy; the administration is not medically necessary as the procedure is FDA-approved only when performed with the specific photosensitizing solution.”

Archived Policies

Category
Policy Title (Number)
Date
Summary of Change
Gastroenterology
DNA Analysis of Stool for Colon Cancer Screening (Cologuard/Cologuard Plus)
Policy #260
10/2/2026
Archived policy; new policy, SH/GENETICS-A18: Genetic Testing: Oncology - Cancer Screening and Surveillance, is now used for review of claims associated with Cologuard/Cologuard Plus.

Additional Announcements

Policy #281: Genetic Testing: Gene Expression Profiling in the Management of Breast Cancer (Effective Dec. 1, 2026)

New section D with coverage criteria for the Breast DCIS test will be included along with addition of a new exclusion for the DCISionRT test: "Select Health does NOT cover the DCISionRT test as peer-reviewed medical literature does not support this test as having sufficient sensitivity or specificity necessary to define a clinical role. (This exclusion does not apply to Nevada Commercial plans, but criteria as outlined in section D above would have to be met)."

Policy #625: Sleep Disorder Evaluation and Treatment (Effective Dec. 1, 2026)

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

Policy #679: Genetic Testing: Cell-Free Fetal DNA Testing (Effective Dec. 1, 2026)

The following exclusionary language will be added: "Select Health covers cell-free fetal DNA testing once per singleton or twin pregnancy, no earlier than 10 weeks gestational age, for the following indications: a. common aneuploidy (chromosomes 13, 18, 21, X, Y) screening b. fetal antigen screening, including RhD status, if the pregnant parent is known to be negative for the antigen being tested."

Policy #SH/LAB-A2: Infectious Disease Testing: Genitourinary (Effective Dec. 1, 2026)

The following exclusion will be added: "Select Health does not cover Nucleic Acid Amplification Testing for prostatitis unless chlamydia and gonorrhea are potential organisms because it lacks sufficient high-quality clinical evidence to prove it improves patient outcomes over standard diagnostic methods; this meets the plan’s definition of experimental/investigational."