Select_health Prior Authorization Lookup
Latest Select_health prior authorization updates9
- Prior AuthClinical/Medical PolicyEff. 2026-07-05Zepbound (tirzepatide) for obstructive sleep apneaPolicy approves Zepbound for Select Health of South Carolina members with moderate to severe obstructive sleep apnea who meet specified clinical and documentation criteria; affects prescribers and prior authorization reviewers.All select_health updates
- Prior AuthClinical/Medical PolicyEff. 2022-05-01Individual Psychotherapy Medical Necessity Review (post-24-visit prior authorization)Select Health requires a medical necessity prior authorization review once a member reaches 24 outpatient individual psychotherapy visits (CPT 90832, 90834, 90837) for private-practice LIPs and RBHS providers rendering outpatient individual psychotherapy. It clarifies submission requirements and limits for subsequent visits.All select_health updates
- Prior AuthClinical/Medical PolicyEff. 2020-02-01Site of Care Medical PharmacyDefines site-of-care prior authorization requirements for select outpatient-administered medical pharmacy drugs when they can be safely administered in the home, in-network infusion center, or in-network office; affects providers seeking reimbursement for outpatient hospital administration. Applies to Medicaid members per policy language.All select_health updates
- Prior AuthClinical/Medical PolicyHepatitis C Antiviral Prior Authorization CriteriaCriteria and documentation requirements for prior authorization of hepatitis C antiviral agents for Select Health members, including preferred agents and treatment-specific testing and prescriber requirements.All select_health updates
- Prior AuthReimbursement/Payment PolicyHome Health Services — Reimbursement PolicyGoverns reimbursement policy for home health services (place of service 12) for Select Health of South Carolina members, including prior authorization, visit limits, and documentation requirements for providers billing on CMS-1500 or UB-04 forms.All select_health updates
- Prior AuthClinical/Medical PolicyLong-acting Opioid Prior Authorization CriteriaCriteria and prior authorization requirements for coverage of long-acting opioid-containing products for Select Health of South Carolina members, including preferred and non-preferred products and clinical requirements for initial and reauthorization approvals.All select_health updates
- Prior AuthClinical/Medical PolicyMedication Assisted Treatment (MAT) CriteriaDefines prior authorization, formulary status, clinical criteria, and coverage duration for buprenorphine-, naloxone-, and naltrexone-based MAT products for members aged 16 and older. Affects prescribers and pharmacy benefit prior authorization reviewers.All select_health updates
- Prior AuthClinical/Medical PolicyShort-acting opioid prior authorization (Select Health of South Carolina)Criteria governing prior authorization for short-acting opioid prescriptions for Select Health of South Carolina members, including initial and reauthorization requirements, age limits, exclusions, and prescriber considerations. Affects prescribers and pharmacy authorization staff.All select_health updates
- Prior AuthReimbursement/Payment PolicyTermination of Pregnancy Reimbursement PolicyDefines Select Health South Carolina's reimbursement stance and requirements for abortion procedures, including medically necessary care for spontaneous or complicated abortions, and specifies prior authorization and documentation requirements when applicable.All select_health updates
Tool Description
Search Select_healthprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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