Select_health Coverage Criteria
Latest Select_health coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Home ultraviolet light therapy equipment for skin conditionsCoverage and medical necessity criteria for home ultraviolet phototherapy devices (primarily narrowband UVB) for photoresponsive skin conditions, and exclusions for UVA/PUVA and nontherapeutic uses; applies to Select Health members when clinician-prescribed and supervised.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-20Epidermal Nerve Fiber Density TestingDefines medical necessity and coverage stance for epidermal (intraepidermal) nerve fiber density testing by skin punch biopsy to detect small fiber neuropathy for Select Health of South Carolina members.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-02Digestive enzyme cartridge (RELiZORB)Defines coverage and limitations for the in-line digestive enzyme cartridge RELiZORB for members with cystic fibrosis and confirmed exocrine pancreatic insufficiency receiving enteral nutrition, including authorization limits and reauthorization conditions.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-01Non-Wheelchair Adaptive SeatingCriteria, documentation, and coding guidance for coverage determinations of non-wheelchair adaptive seating (therapeutic chairs) and related accessories for members of Select Health of South Carolina.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-20Donor human milkCoverage policy for pasteurized donor human milk for infants, focused on high-risk neonates when mother's own milk is unavailable or contraindicated; intended for Select Health of South Carolina coverage determinations.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-20Transcatheter pulmonary valve replacement (TPVR)Defines medical necessity criteria, contraindications, and device coverage for transcatheter pulmonary valve replacement (e.g., Melody, Harmony, SAPIEN 3 with Alterra) for members with pulmonary valve dysfunction and congenital heart disease.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-01Skin Substitutes for Chronic WoundsClinical coverage policy for the use of cellular and acellular skin substitute products for cutaneous wounds and thermal burns, describing medical necessity criteria, limitations, and supporting evidence for providers and claims reviewers.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-10-01Plastic reconstructive surgeryDescribes coverage guidance for plastic (reconstructive) surgical procedures that correct functional impairments and distinguishes reconstructive (medically necessary) from cosmetic (not medically necessary) procedures; applies to Select Health of South Carolina coverage determinations and providers requesting coverage.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-08-01Peristeen® anal irrigation systemCoverage criteria and medical necessity guidance for use of the Peristeen transanal irrigation system for bowel management, affecting Select Health of South Carolina members and treating providers.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-01Speech therapyDefines medical necessity criteria, limitations, and background for speech therapy services (speech disorders, fluency, voice, swallowing, pediatric feeding disorders, and oral aversion) used by Select Health of South Carolina to make coverage determinations for members.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-04-01Customized lymphedema compression garmentsThis policy governs medical necessity and coverage criteria for customized compression garments used to treat lymphedema for Select Health of South Carolina members and describes contraindications, replacement frequency, and related services.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Peroral endoscopic myotomy (POEM)This policy governs coverage and medical necessity criteria for peroral endoscopic myotomy (including esophageal POEM and gastric POEM) for treatment of achalasia and medically refractory gastroparesis in adults, and describes investigational indications and contraindications; it applies to Select Health of South Carolina members and providers making coverage determinations.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-09-01Laser interstitial thermal therapy (LITT) for drug-resistant epilepsyDefines Select Health of South Carolina's coverage stance and medical necessity criteria for MRI-guided laser interstitial thermal therapy to treat drug-resistant (medically intractable) epileptic seizures; applies to providers seeking coverage for members under Select Health plans.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-09-01Prescription digital therapeutics for contraceptionDefines coverage criteria and limitations for FDA-cleared prescription digital therapeutics (mobile apps) used as fertility-awareness contraception methods (Natural Cycles and Clue Birth Control) for eligible female members.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-06-01Inhaled Nitric OxideThis policy governs medical necessity and coverage for inhaled nitric oxide therapy, primarily for newborns with pulmonary hypertension and hypoxemic respiratory failure, and outlines investigational or noncovered uses. It applies to Select Health of South Carolina plan determinations.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-02-01Pediatric Intensive Feeding ProgramsCoverage criteria for outpatient and inpatient pediatric intensive feeding programs for children with diagnosed feeding disorders; intended for Select Health of South Carolina providers and claims reviewers.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-02-01Therapeutic Contact LensesDefines medical necessity and coverage criteria for therapeutic contact lenses (including hydrophilic, gas-permeable scleral, Boston scleral, scleral shell) and amniotic membrane transplantation for ocular surface disease and acute burns; applies to Select Health of South Carolina members and their providers.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-08-01Microwave thermotherapy (ablation) for lung and kidney tumorsPolicy governing coverage determinations for image-guided microwave ablation of primary or metastatic lung tumors and malignant kidney (renal) tumors for Select Health of South Carolina members, including clinical criteria for medical necessity and referenced guideline support.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-08-01Prostatic urethral lift (UroLift) for benign prostatic hyperplasiaDefines coverage criteria, limitations, contraindications, and alternative services for UroLift (prostatic urethral lift) for treatment of lower urinary tract symptoms from benign prostatic hyperplasia for Select Health of South Carolina members.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-04-01Oral Nutritional SupplementsThis policy governs coverage and medical necessity criteria for prescribed oral nutritional supplements, medical foods, and related medical nutrition products for Select Health of South Carolina members. It applies to providers seeking coverage determinations for these products.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-04-01XEN® gel stent for glaucomaPolicy governing medical necessity and coverage limitations for implantation of the XEN45 gel stent for glaucoma, including clinical indications, provider requirements, and alternative covered services for Select Health of South Carolina members.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-03-01Gastroparesis EvaluationsDefines medical necessity criteria, limitations, and alternative diagnostic options for evaluating suspected gastroparesis for Select Health members; affects providers ordering gastric emptying diagnostic tests.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-02-01Platelet rich plasma for nonhealing diabetic woundsThis policy governs coverage of platelet-rich plasma (PRP) for chronic nonhealing diabetic wounds for Select Health of South Carolina members, specifying when PRP is considered medically necessary as an adjunct and required documentation and limits for continued use.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-12-01Specialized infant formulaCoverage rules for oral specialized infant formula for home use in infants aged 12 months or younger, including medical necessity criteria, covered conditions, contraindications, and limitations. Applies to Select Health of South Carolina plan determinations.All select_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-04-01Auricular Stimulation for Abdominal Pain From Irritable Bowel SyndromeCoverage criteria for percutaneous auricular (IB-Stim) nerve field stimulation to treat functional abdominal pain from irritable bowel syndrome in pediatric members and related policy considerations for Select Health of South Carolina.All select_health updates
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Tool Description
Search Select_health coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
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