SelectHealth Prior Authorization Lookup
Latest SelectHealth prior authorization updates25
- Prior AuthReimbursement/Payment PolicyEff. 2026-03-26Commercial codes not covered or requiring preauthorization (Nevada)A quarterly-updated list of CPT/HCPCS procedure codes that are either not covered or require prior authorization for SelectHealth commercial plans in Nevada; affects providers billing Small Employer and Individual commercial plans.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-03-26Commercial codes not covered or requiring prior authorization — ColoradoA quarterly-updated listing of CPT/HCPCS procedure codes that SelectHealth classifies as either not covered or requiring prior authorization for Small Employer and Individual commercial plans in Colorado; providers should verify plan-specific coverage and consult Pharmacy for immunizations/injectables/specialty medications.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-03-26Medicare codes not covered or requiring preauthorization - ColoradoA quarterly-updated list of Medicare procedure codes that SelectHealth either does not cover or requires preauthorization for, specific to Colorado members; applies to coverage determination and prior authorization processes.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-03-26Medicare codes not covered or requiring preauthorization - Utah & IdahoA quarterly-updated list of Medicare procedure codes that either require preauthorization or are not covered for SelectHealth members in Utah and Idaho; applies to plan types where these coding rules are enforced and excludes pharmacy/immunization/specialty medication guidance.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prescription drug listPart 1 of 3 of SelectHealth's prescription drug list (formulary) summarizing commonly prescribed drugs, tier assignments, and plan-level usage flags such as Preauthorization (PA), Maintenance (M), Step Therapy (ST), Quantity Limits (QL), and Age limits (AGE). This part contains formulary policy intro, member guidance, and a long list of drug classes and individual drugs with tier and requirement flags.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prescription drug list (formulary) - Coverage CriteriaSummarizes commonly prescribed drugs covered by SelectHealth plans, explains tiers, cost-sharing, and administrative controls (e.g., prior authorization, step therapy, quantity limits) for members and providers.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prescription drug list (formulary) - Coverage CriteriaThis document is a summary of commonly prescribed drugs covered by SelectHealth plans (the formulary), including tier placement, special requirements (e.g., preauthorization, step therapy, quantity limits, age limits), and guidance for members and providers on coverage and costs.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prescription drug list (formulary) — Coverage CriteriaThis document summarizes commonly prescribed drugs covered by SelectHealth plans, including tier placement, requirements (e.g., prior authorization, step therapy, quantity limits, age limits), and instructions for members and providers on coverage and exceptions.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prescription drug list (formulary) — Coverage criteriaSummary of commonly prescribed drugs covered by SelectHealth plans, tiering, coverage limits, and requirements (e.g., preauthorization, step therapy, quantity limits) for members and providers.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01SelectHealth Prescription Drug List (Formulary) — summary of commonly prescribed drugsThis document is a summary 'drug list' (formulary) describing commonly prescribed medications, their formulary tier, and plan-level controls (preauthorization, step therapy, quantity limits, age limits, maintenance/90-day). It is intended for SelectHealth members, providers, pharmacies, and internal billing/clinical operations.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-12-22Commercial codes not covered or requiring preauthorization (Colorado)A payer-specific listing of procedure codes that are either not covered or require prior authorization for commercial Small Employer and Individual plans in Colorado; affects providers billing SelectHealth commercial plans in Colorado.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-12-22Medicare codes not covered or requiring preauthorization - ColoradoA quarterly-updated listing of Medicare procedure codes that are either not covered or require preauthorization for SelectHealth members in Colorado; applies to coverage determinations and billing for affected services.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-12-22Medicare codes not covered or requiring preauthorization - Utah & IdahoQuarterly-updated list of Medicare procedure codes that SelectHealth identifies as either not covered or requiring preauthorization for members in Utah and Idaho; applies to plan administration and provider billing/authorization processes.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-01Prescription drug list (formulary) — coverage criteriaThis document summarizes commonly prescribed drugs that SelectHealth covers, explains tiers, cost-sharing, and special requirements (preauthorization, step therapy, quantity limits, age limits) and directs members to the full online formulary and pharmacy services for details.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-09-25Commercial CPT/HCPCS codes not covered or requiring preauthorization (Nevada)A payer-maintained list of procedure and service codes that are either not covered or require preauthorization for SelectHealth commercial plans in Nevada; affects providers submitting claims and authorization staff.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2025-09-25Commercial codes not covered or requiring prior authorization — Idaho (quarterly updated code lists)Quarterly-updated code lists (CPT/HCPCS/U-codes/Q-codes) indicating per-plan (Small Employer Individual / Large Employer) Not Covered or Preauthorization Required status for SelectHealth commercial plans in Idaho; excludes immunizations, injectable drugs, and specialty medications managed via Pharmacy.All SelectHealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-09-25Medicare codes not covered or requiring preauthorization (Utah & Idaho)A quarterly-updated list of Medicare procedure codes that are either not covered or require preauthorization for SelectHealth members in Utah and Idaho; includes disclaimers that plan-level coverage may vary and that immunizations and pharmacy items are addressed elsewhere.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-21Compounded MedicationsCoverage criteria for compounded medications across SelectHealth Commercial, Medicare (CMS), and Community Care (Medicaid); specifies when compounded prescriptions are medically necessary and includes billing/coding and prior authorization guidance.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2023-08-01Vagus Nerve Stimulation (VNS) — Neurology/Neurosurgery Coverage CriteriaThis SelectHealth policy governs coverage and clinical criteria for VNS devices and related neuromodulation procedures across Commercial, Medicare (CMS), and Community Care plans, including documentation, prior authorization, and exclusions described for multiple neurostimulation indications.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2023-03-05Wireless Cardiac Monitoring (e.g., CardioMEMS) — Table of Contents entry / partial policyEntry in SelectHealth cardiology policy set describing coverage framework and where the full wireless cardiac monitoring policy appears; affects providers seeking prior authorization and coverage guidance under SelectHealth plans.All SelectHealth updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Prior Authorization Request Form — Drug Benefit (including SUD medications)This document is a SelectHealth prior authorization request form for prescription drug benefits, including requests for medications to treat substance use disorders; it governs submission requirements for providers and pharmacies seeking prior authorization or reauthorization.All SelectHealth updates
- Prior AuthClinical/Medical PolicyActimmune (interferon gamma-1b) — Coverage CriteriaCriteria governing prior authorization and coverage for Actimmune (interferon gamma-1b) for SelectHealth members, including required diagnoses and exclusions. Affects providers requesting coverage under the payer's medical policy.All SelectHealth updates
- Prior AuthClinical/Medical PolicyActimmune (interferon gamma-1b) — Coverage and Prior Authorization CriteriaCoverage and prior authorization requirements for Actimmune (interferon gamma-1b) for SelectHealth members, including required diagnoses and exclusions. Applies to medication benefit determinations for Plan Year authorizations.All SelectHealth updates
- Prior AuthClinical/Medical PolicyActimmune and Akeega prior authorization criteriaDefines prior authorization requirements and coverage criteria for the drugs Actimmune and Akeega for SelectHealth plan members, including indications, exclusions, required documentation, and coverage duration.All SelectHealth updates
- Prior AuthClinical/Medical PolicyActimmune and Akeega prior authorization criteriaSelectHealth prior authorization criteria for Actimmune and Akeega, including required documentation, prerequisite therapy, and PA indications for these medications under the payer's medical/drug benefit.All SelectHealth updates
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Tool Description
Search SelectHealthprior 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.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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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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