*Changes apply ONLY to Commercial plan policy UNLESS summary text appears in bold.
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. The new platform is expected to launch early in the second quarter of 2026.
To support accurate and timely claims payment, it is essential to follow correct coding practices. This includes:
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.
Please be aware that the guidelines for Vitamin D Serum 25-hydroxyvitamin D (25(OH)D) testing and Free Triiodothyronine (T3) testing have recently been updated.
To ensure accurate billing and appropriate use of laboratory services, make sure to review the current medical policy guidelines related to these tests and other applicable laboratory services.
You can access the updated medical policies in the Laboratory Utilization Policies booklet on the Select Health website.
When billing for laboratory services, always ensure that you are selecting the most appropriate procedure code. Correct code selection supports accurate claims processing and helps prevent denials or payment delays.
Key Guideline: When a multianalyte test is performed using a single wet-lab procedure and no specific panel code is available, the service should be billed using: One (1) unit of CPT® 81479 (Unlisted molecular pathology procedure)
This approach ensures proper reporting when established panel codes do not exist for the performed testing.
For detailed guidance, refer to: Coding/Reimbursement Policy: Diagnostic Laboratory and Genetic Test [#CR-100]