| Global Obstetrical/OB Maternity Services Policy | RP044 · Effective May 22, 2026 · Commercial, Medicaid · IL | 34 | Original policy ↗ |
| Global Surgical Package – Professional Provider | RP014 · Effective Apr 10, 2026 · Commercial, Medicaid · IL | 5 | Original policy ↗ |
| Golimumab | RX501.112 · Commercial, Medicaid | 1 | Original policy ↗ |
| Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists | RX501.041 · Commercial, Medicaid | 12 | Original policy ↗ |
| Guselkumab | RX501.175 · Commercial, Medicaid | 1 | Original policy ↗ |
| Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery | SUR701.037 · Commercial, Medicaid | 2 | Original policy ↗ |
| Heart Transplant | SUR703.005 · Commercial, Medicaid | 4 | Original policy ↗ |
| Heart/Lung Transplant | SUR703.006 · Commercial, Medicaid | 11 | Original policy ↗ |
| Heat and Cold Therapy Devices | THE801.004 · Effective Jan 1, 2026 · Commercial, Medicaid | 13 | Original policy ↗ |
| Helicobacter pyloriTesting | RPLAB018 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 19 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia | SUR703.043 · Commercial, Medicaid | 70 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Acute Myeloid Leukemia | SUR703.037 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Autoimmune Diseases | SUR703.036 · Effective Jun 15, 2026 · Commercial, Medicaid | 69 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Breast Cancer | SUR703.038 · Commercial, Medicaid | 67 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma | SUR703.039 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) | SUR703.029 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia | SUR703.041 · Commercial, Medicaid | 67 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer | SUR703.034 · Commercial, Medicaid | 67 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias | SUR703.033 · Commercial, Medicaid | 67 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Hodgkin Lymphoma | SUR703.040 · Effective Apr 15, 2026 · Commercial, Medicaid | 69 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults | SUR703.035 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas | SUR703.031 · Effective May 1, 2026 · Commercial, Medicaid | 72 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome | SUR703.030 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Primary Systemic Amyloidosis | SUR703.046 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Solid Tumors of Childhood | SUR703.044 · Effective Jun 15, 2026 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia | SUR703.050 · Commercial, Medicaid | 68 | Original policy ↗ |
| Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors | SUR703.045 · Commercial, Medicaid | 70 | Original policy ↗ |
| Hepatitis Testing | RPLAB015 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 22 | Original policy ↗ |
| Hernia Repair | RP012 · Effective Jul 10, 2026 · Commercial, Medicaid · IL | 69 | Original policy ↗ |
| High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell’s Palsy | MED201.057 · Effective Oct 15, 2025 · Commercial, Medicaid | 3 | Original policy ↗ |
| Hip Resurfacing | SUR705.019 · Commercial, Medicaid | 3 | Original policy ↗ |
| HMO Claims Processing | 257467.0426 · Commercial, Medicaid · IL | — | Original policy ↗ |
| HMO Coordination of Benefits | Commercial · IL | — | Original policy ↗ |
| HMO Membership Information | 257468.0426 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Home Cardiorespiratory Monitoring | DME101.020 · Commercial, Medicaid | 8 | Original policy ↗ |
| Home Health Care Policy | RP005 · Effective Mar 9, 2026 · Commercial, Medicaid · IL | 34 | Original policy ↗ |
| Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and Failure | MED204.007 · Effective May 15, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Hormone Replacement Therapies | RX501.007 · Effective Aug 1, 2026 · Commercial, Medicaid | 15 | Original policy ↗ |
| Hospital Beds and Related Equipment | DME101.001 · Commercial, Medicaid | 58 | Original policy ↗ |
| Human Growth Hormone (GH) | RX501.040 · Effective Jan 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Human Immunodeficiency Virus (HIV) | RPLAB065 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 25 | Original policy ↗ |
| Hyperbaric Oxygen (HBO2) Therapy | THE801.003 · Effective Jan 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies | SUR701.029 · Commercial, Medicaid | 10 | Original policy ↗ |
| Ibalizumab-uiyk | RX501.099 · Effective Apr 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Identification of Microorganisms Using Nucleic Acid Probes | CPCPLAB063 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 28 | Original policy ↗ |
| Identification of Microorganisms Using Nucleic Acid Probes | RPLAB063 · Effective Dec 4, 2026 · Commercial, Medicaid · IL | 29 | Original policy ↗ |
| Image-Guided Minimally Invasive Decompression for Spinal Stenosis | SUR712.035 · Commercial, Medicaid | 3 | Original policy ↗ |
| Immune Cell Function Assay | CPCPLAB028 · Effective May 1, 2026 · Commercial, Medicaid · IL | 3 | Original policy ↗ |
| Immunoglobulin Therapy | RX504.003 · Commercial, Medicaid | 30 | Original policy ↗ |
| Immunohistochemistry | CPCPLAB069 · Effective May 1, 2026 · Commercial, Medicaid · IL | 3 | Original policy ↗ |