| Sepsis Policy | CPCP041 · Effective Apr 30, 2026 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases | MED207.159 · Commercial, Medicaid | 20 | Original policy ↗ |
| Serum Tumor Markers for Malignancies | RPLAB037 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 59 | Original policy ↗ |
| Sexual Dysfunctions, Assessment and Treatment | MED201.030 · Commercial, Medicaid | 64 | Original policy ↗ |
| Shoulder Resurfacing | SUR705.032 · Commercial, Medicaid | 3 | Original policy ↗ |
| Sleep Related Breathing Disorders: Surgical Management | SUR706.009 · Effective Jan 1, 2026 · Commercial, Medicaid | 40 | Original policy ↗ |
| Small Bowel/Liver and Multivisceral Transplant | SUR703.009 · Commercial, Medicaid | 26 | Original policy ↗ |
| Specialty Medication Administration Site of Care | ADM1001.034 · Commercial | 123 | Original policy ↗ |
| Speech Generating Devices (SGD) | DME104.009 · Commercial, Medicaid | 13 | Original policy ↗ |
| Speech-Language Therapy (SLT) | THE803.014 · Commercial, Medicaid | 13 | Original policy ↗ |
| Spesolimab-sbzo | RX501.181 · Commercial, Medicaid | 1 | Original policy ↗ |
| Sphenopalatine Ganglion Block for Headache | MED205.039 · Effective Aug 15, 2025 · Commercial, Medicaid | 7 | Original policy ↗ |
| Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation | SUR712.009 · Effective Aug 1, 2026 · Commercial, Medicaid | 30 | Original policy ↗ |
| Stationary Ultrasonic Diathermy Devices | THE801.039 · Commercial, Medicaid | 2 | Original policy ↗ |
| Stem Cell Therapy for Peripheral Arterial Disease | SUR703.048 · Effective Apr 15, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy | MED206.006 · Commercial, Medicaid | 3 | Original policy ↗ |
| Subtalar Arthroereisis | SUR705.027 · Commercial, Medicaid | 5 | Original policy ↗ |
| Surface Electrical Stimulation | MED201.026 · Commercial, Medicaid | 7 | Original policy ↗ |
| Surface Electromyography and Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain | MED205.006 · Effective Oct 1, 2025 · Commercial, Medicaid | 6 | Original policy ↗ |
| Surgery for Groin Pain in Athletes | SUR705.036 · Commercial, Medicaid | 3 | Original policy ↗ |
| Surgical Deactivation of Headache Trigger Sites | SUR712.031 · Commercial, Medicaid | 12 | Original policy ↗ |
| Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation | SUR707.033 · Effective Jan 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Surgical Treatment of Femoroacetabular Impingement | SUR705.029 · Commercial, Medicaid | 7 | Original policy ↗ |
| Surgical Treatment of Gynecomastia | SUR716.017 · Commercial, Medicaid | 2 | Original policy ↗ |
| Surgical Treatments for Breast Cancer-Related Lymphedema | SUR701.024 · Effective Dec 15, 2025 · Commercial, Medicaid | 17 | Original policy ↗ |
| Surgical Ventricular Restoration | SUR707.026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Sutimlimab-jome | RX501.180 · Commercial, Medicaid | 1 | Original policy ↗ |
| Telemedicine and Telehealth/Virtual Health Care Services Policy | RP033 · Effective Mar 27, 2026 · Commercial, Medicaid · IL | 30 | Original policy ↗ |
| Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia | MED201.025 · Effective Apr 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Temporomandibular Joint Disorders | SUR705.010 · Commercial, Medicaid | 96 | Original policy ↗ |
| Teplizumab-mzwv | RX501.150 · Effective Apr 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Teprotumumab-trbw | RX501.110 · Commercial, Medicaid | 1 | Original policy ↗ |
| Testing for Alpha-1 Antitrypsin Deficiency | CPCPLAB061 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 4 | Original policy ↗ |
| Testing for Alpha-1 Antitrypsin Deficiency | RPLAB061 · Effective Dec 4, 2026 · Commercial, Medicaid · IL | 4 | Original policy ↗ |
| Testing for Diagnosis of Active or Latent Tuberculosis | CPCPLAB027 · Effective Apr 24, 2026 · Commercial, Medicaid · IL | 31 | Original policy ↗ |
| Testing for Vector-Borne Infections | CPCPLAB052 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 26 | Original policy ↗ |
| Testing of Homocysteine Metabolism-Related Conditions | CPCPLAB067 · Effective May 1, 2026 · Commercial, Medicaid · IL | 6 | Original policy ↗ |
| Testosterone | CPCPLAB009 · Effective May 1, 2026 · Commercial, Medicaid · IL | 8 | Original policy ↗ |
| Tests for Amniotic Protein to Detect Rupture of Membranes (ROM) in Pregnancy | OB401.018 · Commercial, Medicaid | 2 | Original policy ↗ |
| Tezepelumab-ekko | RX501.143 · Commercial, Medicaid | 1 | Original policy ↗ |
| Therapeutic Embolization and Vessel Occlusion to Treat Pelvic Conditions | SUR701.015 · Effective Jan 1, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding | RP026 · Effective Aug 28, 2026 · Commercial, Medicaid · IL | 37 | Original policy ↗ |
| Thermography | RAD601.014 · Commercial, Medicaid | 2 | Original policy ↗ |
| Thyroid Disease Testing | RPLAB019 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 16 | Original policy ↗ |
| Tibial Nerve Stimulation | MED205.035 · Effective Jan 1, 2026 · Commercial, Medicaid | 11 | Original policy ↗ |
| Tildrakizumab-asmn | RX501.123 · Commercial, Medicaid | 1 | Original policy ↗ |
| Tocilizumab and Associated Biosimilar(s) | RX501.115 · Commercial, Medicaid | 4 | Original policy ↗ |
| Tonic Motor Activation for Restless Legs Syndrome | DME101.053 · Effective Apr 15, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Transanal Endoscopic Microsurgery | SUR701.040 · Effective Apr 1, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Transanal Radiofrequency (RF) Treatment of Fecal Incontinence | MED201.029 · Commercial, Medicaid | 1 | Original policy ↗ |