Medical Policies/Coding and Reimbursement

Access SelectHealth Medical Policies as a collection (in PDF form) for each category in the linked lists at right.  For help finding the exact policy you need within each collection, review the information on Navigating Medical Policy Collections.

Note: Policies are also available on the SelectHealth Provider Portal​ (secure login required).  On the portal, all policies can be accessed alphabetically as well by category.  In addition, archived policies will continue to be available on the Portal.

Medical policies are based on SelectHealth determination of whether particular services or devices are standard medical practice, experimental/investigational, cosmetic, or within coding standards.  These 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

Update Bulletins for Medical Policies and Coding and Reimbursement**

Now published monthly, you can access these bulletins, beginning September 2020 (previous updates were published in each issue of Provider Insight​ issues in February, May, and August).  Latest update bulletins include:

*The appearance of a policy in the Medical Policy Update Bulletin indicates that SelectHealth has recently adopted or revised a C&R policy but does not indicate whether or not SelectHealth provides coverage for the procedures listed. For any inconsistency or conflict between the information provided in this bulletin and the posted medical policy, the provisions of the posted policy will prevail.

**Coding and Reimbursement policies are based on a SelectHealth review of currently available clinical information including coding standards set by:
  • Centers for Medicare and Medicaid Services (CMS)
  • Current Procedural Terminology (CPT)
  • Specialty Societies (e.g., AAOS)
  • Other expert sources ​
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