| Preferred Glucometer Program | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Pregnancy: Your Birth Options After Cesarean | Commercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI | — | Original policy ↗ |
| Preoperative Testing for Low Risk Invasive Procedures and Surgeries | CG-MED-61 · Commercial | 16 | Original policy ↗ |
| Presentation | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Presentation | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Presentation | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Presentation | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Preventive Care Services Covered with No Member Cost-share | Commercial · CT, ME, NH | — | Original policy ↗ |
| Preventive Medicine Services with Screening and other Evaluation and Management Services – Professional | C-12002 · Effective Apr 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 54 | Original policy ↗ |
| Prior Authorization List | Commercial · CT | — | Original policy ↗ |
| Prior Authorization Request: Inpatient or Outpatient | Commercial · CT, NH | — | Original policy ↗ |
| Prolonged Services – Professional | C-08011 · Effective Jun 3, 2025 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI | 12 | Original policy ↗ |
| Provider Agreement Affiliates List | Commercial, Medicaid · CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, WI | — | Original policy ↗ |
| Provider Appeals | Commercial · CO, CT | — | Original policy ↗ |
| Provider Digital Engagement Supplement | MULTI-BCBS-CRCM-023353-23-CPN21196 · Commercial, Medicaid · CO, CT, GA, MO, NH | — | Original policy ↗ |
| Provider Preventable Conditions – Professional and Facility | C-23002 · Effective Sep 1, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Quantitative Muscle Testing Devices | MED.00089 · Commercial | 1 | Original policy ↗ |
| Quantitative Sensory Testing | MED.00082 · Commercial | 6 | Original policy ↗ |
| RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care | RAD.00038 · Commercial | 3 | Original policy ↗ |
| RAD.00044 Magnetic Resonance Neurography | RAD.00044 · Commercial | 1 | Original policy ↗ |
| RAD.00053 Cervical and Thoracic Discography | RAD.00053 · Commercial | 2 | Original policy ↗ |
| RAD.00064 Myocardial Sympathetic Innervation Imaging with or without Single-Photon Emission Computed Tomography (SPECT) | RAD.00064 · Commercial | 2 | Original policy ↗ |
| RAD.00067 Quantitative Ultrasound for Tissue Characterization | RAD.00067 · Commercial | 2 | Original policy ↗ |
| RAD.00068 Myocardial Strain Imaging | RAD.00068 · Commercial | 3 | Original policy ↗ |
| Remote Devices for Intermittent Monitoring of Intraocular Pressure | DME.00050 · Commercial | 1 | Original policy ↗ |
| Respiratory Viral Panel Testing in the Outpatient Setting | CG-LAB-14 · Commercial | 10 | Original policy ↗ |
| Review of Services for Benefit Determinations in the Absence of a Company Applicable Medical Policy or Clinical Utilization Management (UM) Guideline | ADMIN.00006 · Commercial | — | Original policy ↗ |
| Robotic Arm Assistive Devices | DME.00044 · Commercial | 1 | Original policy ↗ |
| Roster Automation Rules of Engagement | MULTI-BCBS-CRCM-26126-23-CPN25245 · Commercial · CO, CT, GA, NH, OH, VA | — | Original policy ↗ |
| Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence | CG-SURG-95 · Commercial | 19 | Original policy ↗ |
| Seat Lift Mechanisms | CG-DME-25 · Commercial | 5 | Original policy ↗ |
| Selected Protein Biomarker Algorithmic Assays | LAB.00011 · Commercial | 9 | Original policy ↗ |
| Serum Biomarker Tests for Risk of Preeclampsia | LAB.00040 · Commercial | 8 | Original policy ↗ |
| Sleep Studies and Related Bundled Services and Supplies – Professional and Facility | C-09009 · Effective Nov 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 12 | Original policy ↗ |
| Small Bowel, Small Bowel/Liver and Multivisceral Transplantation | TRANS.00013 · Commercial | 17 | Original policy ↗ |
| SoloHealth Station | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Specialty Pharmacy Program Expansion - Level of Care Review FAQs | CG-DRUG-47 · Commercial · CT | — | Original policy ↗ |
| Split-Care Surgical Modifiers - Professional | C-23004 · Effective Jun 14, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Standby Services- Professional | C-09005 · Effective May 5, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 5 | Original policy ↗ |
| Substance Brief Intervention/Referral Tool (SBIRT) | Commercial, Medicaid · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI | 6 | Original policy ↗ |
| SURG.00008 Mechanized Spinal Distraction Therapy | SURG.00008 · Commercial | 2 | Original policy ↗ |
| SURG.00011 Products for Wound Healing and Soft Tissue Grafting: Investigational | SURG.00011 · Commercial | 377 | Original policy ↗ |
| SURG.00019 Transmyocardial Revascularization | SURG.00019 · Commercial | 3 | Original policy ↗ |
| SURG.00023 Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures | SURG.00023 · Commercial | 30 | Original policy ↗ |
| SURG.00032 Patent Foramen Ovale and Left Atrial Appendage Closure Devices | SURG.00032 · Commercial | 1 | Original policy ↗ |
| SURG.00043 Electrothermal Shrinkage of Joint Capsules, Ligaments, and Tendons | SURG.00043 · Commercial | 2 | Original policy ↗ |
| SURG.00044 Breast Ductal Examination and Fluid Cytology Analysis | SURG.00044 · Commercial | 1 | Original policy ↗ |
| SURG.00045 Extracorporeal Shock Wave Therapy | SURG.00045 · Commercial | 6 | Original policy ↗ |
| SURG.00052 Percutaneous Vertebral Disc Procedures | SURG.00052 · Commercial | 3 | Original policy ↗ |
| SURG.00056 Transanal Radiofrequency Treatment of Fecal Incontinence | SURG.00056 · Commercial | 1 | Original policy ↗ |
