| Partial Hospitalization Program and Intensive Outpatient Program Services - Facility | C-19002 · Effective Jul 23, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Past medical history and medication linking in the medical record | Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI | — | Original policy ↗ |
| Percutaneous Spinal Surgery | SURG.00071 · Commercial | 8 | Original policy ↗ |
| Pharmaceutical Waste – Professional and Facility | C-11031 · Effective Sep 11, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 2 | Original policy ↗ |
| Physician Extenders | CRHPAP - 001 · Effective Oct 1, 2016 · Commercial · IN, KY, MO, OH, WI | — | Original policy ↗ |
| Physician Extenders | CRHPAP - 001 · Effective Oct 1, 2016 · Commercial · IN, KY, MO, OH, WI | — | Original policy ↗ |
| Place of Service - Professional | C-24004 · Effective Dec 10, 2024 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Portable Normothermic Organ Perfusion Systems | TRANS.00039 · Commercial | 10 | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Nov 14, 2025 · Medicaid · IN | — | Original policy ↗ |
| Powered Robotic Lower Body Exoskeleton Devices | OR-PR.00006 · Commercial | 2 | Original policy ↗ |
| Practitioner Credentialing Rights | Commercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI | — | Original policy ↗ |
| Preadmission Services for Inpatient Stays | G-01017 · Effective Sep 11, 2025 · Medicaid · IN | — | 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 ↗ |
| Preventive Care Services Covered with No Member Cost-share (updated December 2021) | Commercial · IN, KY, MO, OH, WI | — | 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 ↗ |
| Professional Anesthesia Services | G-07018 · Effective Nov 14, 2025 · Medicaid · IN | 2 | 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 ↗ |
| Proof of Timely Filing | G-06133 · Effective Oct 23, 2025 · Medicaid · IN | — | 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 · IN, KY, MO, WI | — | Original policy ↗ |
| Provider Claim Issue Escalation to Network Relations | Commercial · IN | — | Original policy ↗ |
| Provider Digital Engagement Supplement | INBCBS-CDCRCM-023341-23-CPN21196 · Commercial, Medicaid · IN | — | Original policy ↗ |
| Provider Preventable Conditions | G-20003 · Effective Mar 22, 2023 · Medicaid · IN | — | 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 ↗ |
| Quality Health First FAQs | Commercial, Medicaid · IN | — | 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 ↗ |
| Reimbursement for Items under Warranty | G-06112 · Effective Sep 11, 2025 · Medicaid · IN | — | Original policy ↗ |
| Remote Devices for Intermittent Monitoring of Intraocular Pressure | DME.00050 · Commercial | 1 | Original policy ↗ |
| Resident Services | CRHPAP - 002 · Effective Feb 14, 2019 · Commercial · IN, KY, MO, OH, WI | — | 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 | Commercial · IN | — | 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 ↗ |
| Split Care Surgical Modifiers | G-11005 · Effective Aug 18, 2025 · Medicaid · IN | — | 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 ↗ |
