Select Health policies
Our policies determine what we consider standard medical practice, experimental/investigational, cosmetic, or within coding standards.
We know policy clarifications can raise important questions about patient care, billing, and reimbursement. This FAQ is designed to help providers understand Select Health’s “incident-to” policy, what it means for their practice, and where to go for additional support.
Question
Answer
What is Select Health's "incident-to" policy?
This is a policy that governs appropriate billing and reimbursement when services are rendered by someone other than the supervising and billing provider.
Why did Select Health make this change?
The criteria itself has not changed. Instead, we're clarifying our intent around the existing policy to ensure appropriate billing and application of care administered to Select Health members.
When does Select Health's "incident-to" policy go into effect?
Technically, Select Health's "incident-to" policy is already in effect. Enforcement efforts will commence on November 1, 2026 going forward.
Can initial care evaluations be performed by a provider NOT credentialed/contracted with Select Health?
No. Initial evaluations must always be performed by a Select Health credentialed/contracted provider in order to be reimbursed under "incident-to."
Does Select Health plan to change this policy in the near future?
Changes to the policy criteria are not anticipated in the near future, but we will continue to respond to questions for clarification.
Does Select Health's "incident-to" policy affect commercial plans?
Yes. Select Health follows CMS guidelines for government-based plans and has extended that guidance to all Select Health plans including commercial plans.
Does Select Health's "incident-to" polcy reflect industry standards?
Yes. Many payers have similar guidelines, which are based on CMS standards.
What is the difference between direct and general supervision?
Supervision requirements are different for medical providers and mental health providers. For medical providers, direct supervision is required, meaning the supervising provider must be physically present and available on-site. For mental health providers, general supervision is required, where there is oversight from the supervising provider and sign-off, but they are not required to be physically present.
After initial evaluation, can a non-credentialed and non-contracted provider that is provisionally licensed provide care for existing Select Health members under the supervision of the supervising provider?
Yes. Once a Select Health credentialed/contracted provider conducts the initial evaluation, subsequent visits can be performed by supervised provisionally licensed providers. All other "incident-to" criteria must be met.
Can another provider or assistant provider be present for initial patient evaluations and be reimbursed under "incident-to"?
Yes, with patient consent, providers have discretion to allow other supervised providers, students, etc. to attend an initial evaluation, but those supervised cannot perform the initial evaluation to be reimbursed under "incident-to.
Can initial evaluations be performed by supervised providers when that initial evaluation is reviewed by the supervising provider at a later time?
No. A supervising provider that is a Select Health credentialed/contracted provider must conduct the initial evaluation. A supervised provider can continue the care plan when they are provisionally licensed and meet "incident-to" criteria.
Can practicum students, interns, non-credentialed providers, or assistant providers bill for services or see patients?
For any provider to bill Select Health in accordance with "incident-to", they must be at least provisionally licensed. Independent of Select Health billing or policies, members can be seen without Select Health reimbursement as agreed upon with the member.
Can providers practicing under direct supervision bill for services?
No, according to "incident-to" criteria a provider practicing under direct supervision would be required to bill under the supervising provider.
Does a Masters-Level exception exist relative to the initial care evaluation requirement?
No. In all cases, a provider currently credentialed/contracted with Select Health must perform the initial evaluation of a Select Health member in order to bill for these services. No exceptions.
Does this policy restrict non-credentialed providers from seeing patients?
Fully licensed, but non-credentialed, providers could bill Select Health for payment for members only as an out-of-network provider.
Will my supervising provider need to re-evaluate past Select Health patients in order to be compliant with this policy?
The policy requires that initial evaluations must be performed by a Select Health credentialed/contracted provider for new patients beginning on November 1, 2026. Existing patients will be grandfathered in, and provisionally licensed providers will continue to be able to bill under "incident-to." Supervised providers who are not provisionally licensed will not be able to bill under "incident-to" for reimbursement, and an initial evaluation will need to performed again with a credentialed/contracted provider.
Does this policy restrict student providers from seeing patients?
Providers can use students who are not provisionally licensed at their discretion, but they cannot bill under "incident-to."
Are Tele-Health-Only provisionally licensed clinicians able to perform an initial evaluation without a supervising provider?
No, only Select Health fully credentialed/contracted providers are able to perform initial evaluations and develop initial treatment plans as always.
Does a supervising provider need to make changes to the care plan?
Yes. A supervising provider that is a Select Health credentialed/contracted provider must always make official changes to any Select Health member's care plan, including medication regimens. Upon completion of these changes by the supervising provider, a supervised provider can continue the care plan given they are at least provisionally licensed and meet the full criteria of the "incident-to" policy.
I have several Select Health patients in sensitive care situations and have concerns about disruption for their treatment. Will this policy affect the care of these patients?
The policy requires that initial evaluations must be performed by a Select Health credentialed/contracted provider for new patients beginning on November 1, 2026. Existing patients will be grandfathered in and provisionally licensed providers will continue to be able to bill under "incident-to." If you are not a provisionally licensed provider, you will not be able to bill under "incident-to" and an initial evaluation will need to performed again with a Select Health credentialed/contracted provider.
Will a patient who switches to a Select Health plan need to have their new initial care evaluation done by a provider who is credentialed/contracted through Select Health to continue treatment?
The policy requires that initial evaluations must be performed by a Select Health credentialed/contracted provider for new patients beginning on November 1, 2026. Existing patients will be grandfathered in and provisionally licensed providers will continue to be able to bill under "incident-to." If you are not a provisionally licensed provider, you will not be able to bill under "incident-to" and an initial evaluation will need to performed again with a Select Health credentialed/contracted provider.
What specific CPT codes may be affected by this?
Several CPT codes will be affected. Please review the policy and CMS documentation for additional information. Please contact your provider representative for help with this question. Utah: UTProviderRelations@Selecthealth.org, Idaho: IDProviderRelations@selecthealth.org, Nevada: NVProviderRelations@selecthealth.org, Colorado: COProviderRelations@selecthealth.org
Who can I contact to ask more questions about this change?
Please contact your provider representative for help with this question. Utah: UTProviderRelations@Selecthealth.org, Idaho: IDProviderRelations@selecthealth.org, Nevada: NVProviderRelations@selecthealth.org, Colorado: COProviderRelations@selecthealth.org
Select Health medical, dental, and coding/reimbursement policies represent our determination of whether services or devices are standard medical practice, experimental/investigational, cosmetic, or within coding standards. NOTE: By accessing and/or downloading Select Health policies, you automatically agree to the Medical and Coding/Reimbursement Policy Manual Terms and Conditions.
The above conclusions reflect our review of currently available clinical information including:
- Research in peer-reviewed published medical literature
- Regulatory status of the technology
- Evidence-based guidelines of public health and health research agencies
- Evidence-based guidelines and positions of leading national health professional organizations
- Views of physicians practicing in relevant clinical areas
- Other relevant factors
Coding & Reimbursement policies are based on a review of coding standards, including:
- Centers for Medicare and Medicaid Services (CMS)
- Current Procedural Terminology (CPT®)
- Specialty societies (e.g., AAOS)
- Other expert sources
Using the new policy search function is easy. See a video tutorial and supporting information here.
- View member pharmacy policies state by state and by drug here.
- Use PromptPA to obtain preauthorization for prescriptions and infusible drugs and to see pharmacy coverage requirements.
- To submit a pharmacy-related appeal, please follow this simple process:
- Step 1: Access the online appeals form.
- Step 2: On the appeals form, be sure to select plan, fill in required fields, and attach supporting documentation (if necessary).
- Step 3: Click the submit button at the bottom right of the form.
Select Health uses InterQual coverage criteria when medical policy is not available. This information can be obtained by signing into the One Healthcare ID portal.
Gain access to MCG Criteria for care given to Select Health Medicare Nevada members.
Laboratory utilization policies reflect a collaboration between Select Health and Concert. Learn more by accessing the frequently asked questions