| Continuous Passive Motion in the Home Setting | DME101.023 · Commercial, Medicaid | 3 | Original policy ↗ |
| Coordination of Community Support and Services for Enrollees in HCBS Waivers and Long-term Care Residential Coordination of Services | Medicaid · IL | — | Original policy ↗ |
| Corneal Collagen Cross-Linking | OTH903.028 · Commercial, Medicaid | 5 | Original policy ↗ |
| Corneal Hysteresis | OTH903.031 · Commercial, Medicaid | 1 | Original policy ↗ |
| Coronavirus Testing in the Outpatient Setting | CPCPLAB057 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 12 | Original policy ↗ |
| Coronavirus Testing in the Outpatient Setting | RPLAB057 · Effective Dec 4, 2026 · Commercial, Medicaid · IL | 12 | Original policy ↗ |
| Corrected Claim Submissions | CPCP025 · Effective Dec 1, 2025 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Cosmetic and Reconstructive Procedures | SUR716.001 · Commercial, Medicaid | 62 | Original policy ↗ |
| Cranial Electrotherapy Stimulation and Auricular Electrostimulation | SUR702.019 · Effective Sep 1, 2026 · Commercial, Medicaid | 11 | Original policy ↗ |
| Crizanlizumab-tmca | RX501.126 · Commercial, Medicaid | 1 | Original policy ↗ |
| Crovalimab-akkz | RX501.176 · Commercial, Medicaid | 1 | Original policy ↗ |
| Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone | SUR701.018 · Effective Jan 1, 2026 · Commercial, Medicaid | 11 | Original policy ↗ |
| Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis | SUR706.020 · Effective Jun 15, 2025 · Commercial, Medicaid | 6 | Original policy ↗ |
| Cryosurgical Ablation of Primary or Metastatic Liver Tumors | SUR701.032 · Commercial, Medicaid | 5 | Original policy ↗ |
| Custodial Care | ADM1001.014 · Commercial, Medicaid | 13 | Original policy ↗ |
| Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty) | SUR712.037 · Effective Nov 15, 2025 · Commercial, Medicaid | 3 | Original policy ↗ |
| Deep Brain Stimulation | SUR712.025 · Effective Sep 15, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Delandistrogene moxeparvovec-rokl | RX501.163 · Effective Jan 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Denosumab and Biosimilars for Non-Oncologic Indications | RX501.140 · Commercial, Medicaid | 14 | Original policy ↗ |
| Dental Services | 255230.0725 · Medicaid · IL | — | Original policy ↗ |
| Depemokimab-ulaa | RX501.192 · Effective Sep 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Dermatologic Applications of Photodynamic Therapy | THE801.027 · Commercial, Medicaid | 6 | Original policy ↗ |
| Device Therapies for Gastroesophageal Reflux Disease (GERD) | MED201.016 · Effective Jan 1, 2026 · Commercial, Medicaid | 10 | Original policy ↗ |
| Diabetes Mellitus Testing | CPCPLAB004 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 6 | Original policy ↗ |
| Diabetes Mellitus Testing | RPLAB004 · Effective Dec 4, 2026 · Commercial, Medicaid · IL | 7 | Original policy ↗ |
| Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis | MED202.064 · Commercial, Medicaid | 6 | Original policy ↗ |
| Diagnosis of Idiopathic Environmental Intolerance | CPCPLAB023 · Effective May 1, 2026 · Commercial, Medicaid · IL | 42 | Original policy ↗ |
| Diagnosis of Obstructive Sleep Apnea Syndrome | MED204.005 · Effective Jan 1, 2026 · Commercial, Medicaid | 14 | Original policy ↗ |
| Diagnosis of Vaginitis | CPCPLAB059 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 27 | Original policy ↗ |
| Diagnostic Testing of Influenza | RPLAB033 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 9 | Original policy ↗ |
| Diagnostic Testing of Iron Homeostasis and Metabolism | CPCPLAB008 · Effective May 1, 2026 · Commercial, Medicaid · IL | 7 | Original policy ↗ |
| Digital Health Technologies for Attention Deficit/Hyperactivity Disorder | PSY301.022 · Commercial, Medicaid | 5 | Original policy ↗ |
| Digital Health Technologies: Diagnostic Applications | PSY301.024 · Effective Dec 15, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Digital Health Technologies: Therapeutic Applications | PSY301.025 · Effective Dec 15, 2025 · Commercial, Medicaid | 6 | Original policy ↗ |
| Donanemab-azbt | RX501.177 · Commercial, Medicaid | 1 | Original policy ↗ |
| Drug Testing in Pain Management and Substance Use Disorder Treatment | MED207.154 · Commercial, Medicaid | 85 | Original policy ↗ |
| Drug Testing Policy | CPCP020 · Effective Mar 20, 2026 · Commercial, Medicaid · IL | 8 | Original policy ↗ |
| Drug-Coated Urethral Balloon for Obstructive Urinary Symptoms | SUR710.026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Drug-Eluting Sinus Implants | SUR706.021 · Effective Jan 1, 2026 · Commercial, Medicaid | 7 | Original policy ↗ |
| Dry Needling of Trigger Points for Myofascial Pain | SUR702.018 · Commercial, Medicaid | 3 | Original policy ↗ |
| Durable Medical Equipment (DME) Reference List | DME101.000 · Effective Sep 15, 2026 · Commercial, Medicaid | 67 | Original policy ↗ |
| Dynamic Posturography | MED205.026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Dynamic Spinal Visualization and Vertebral Motion Analysis | RAD601.046 · Commercial, Medicaid | 5 | Original policy ↗ |
| Eculizumab and Associated Biosimilar(s) | RX501.066 · Commercial, Medicaid | 8 | Original policy ↗ |
| Edaravone | RX501.095 · Commercial, Medicaid | 1 | Original policy ↗ |
| Efgartigimod alfa-fcab or Efgartigimod alfa and hyaluronidase-qvfc | RX501.141 · Commercial, Medicaid | 2 | Original policy ↗ |
| Electrical and Electromagnetic Stimulation for the Treatment of Arthritis | MED201.042 · Effective Sep 15, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Electrical Bone Growth Stimulation of the Appendicular Skeleton | SUR705.044 · Commercial, Medicaid | 4 | Original policy ↗ |
| Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures | SUR705.013 · Commercial, Medicaid | 4 | Original policy ↗ |
| Electrostimulation and Electromagnetic Therapy for Treating Wounds | MED201.027 · Commercial, Medicaid | 12 | Original policy ↗ |
