| Implant, Device and Tissue Policy | RP007 · Effective Aug 28, 2026 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Implantable Bone-Conduction and Bone-Anchored Hearing Aids | SUR714.003 · Effective Jan 1, 2026 · Commercial, Medicaid | 20 | Original policy ↗ |
| Implantable Cardioverter Defibrillators | SUR707.003 · Effective Dec 15, 2025 · Commercial, Medicaid | 59 | Original policy ↗ |
| Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | MED205.042 · Commercial, Medicaid | 36 | Original policy ↗ |
| In Vitro Chemoresistance and Chemosensitivity Assays | CPCPLAB030 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 16 | Original policy ↗ |
| Inclisiran | RX501.142 · Effective Jan 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Increased Procedural Services, Modifier 22 – Professional Provider | RP013 · Effective Apr 10, 2026 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Inebilizumab-cdon | RX501.127 · Effective May 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Infliximab and Associated Biosimilars | RX501.051 · Effective Jan 1, 2026 · Commercial, Medicaid | 6 | Original policy ↗ |
| Infrared Therapy Devices | DME101.045 · Commercial, Medicaid | 3 | Original policy ↗ |
| Infusion Services | RP019 · Effective Dec 11, 2026 · Commercial, Medicaid · IL | 106 | Original policy ↗ |
| Infusion Services v2 | CPCP019 · Effective Jul 18, 2025 · Commercial, Medicaid · IL | 92 | Original policy ↗ |
| Inhaled Nitric Oxide | THE801.038 · Commercial, Medicaid | 1 | Original policy ↗ |
| Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence | SUR710.008 · Commercial, Medicaid | 6 | Original policy ↗ |
| Injectable Clostridial Collagenase for Fibroproliferative Disorders | RX501.073 · Commercial, Medicaid | 9 | Original policy ↗ |
| Inpatient Readmissions - Facility Services | CPCP027 · Effective Dec 19, 2025 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Inpatient/Outpatient Unbundling Policy - Facility | CPCP002 · Effective Mar 13, 2026 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Inside the U.S. Food and Drug Administration (FDA) | ADM1001.028 · Commercial, Medicaid | 4 | Original policy ↗ |
| Insulin Potentiation Therapy | THE801.035 · Commercial, Medicaid | 1 | Original policy ↗ |
| Interferential Current Stimulation | MED201.041 · Commercial, Medicaid | 7 | Original policy ↗ |
| Intermittent Intravenous Insulin Therapy | MED201.028 · Commercial, Medicaid | 1 | Original policy ↗ |
| Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers) | SUR712.029 · Effective Nov 1, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Interspinous Fixation (Fusion) Devices | SUR712.040 · Effective Nov 15, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Interventions for Progressive Scoliosis | SUR705.046 · Effective Sep 1, 2026 · Commercial, Medicaid | 37 | Original policy ↗ |
| Intracellular Micronutrient Analysis | MED207.088 · Commercial, Medicaid | 7 | Original policy ↗ |
| Intraocular Lens (IOLs) and Implantable Miniature Telescope (IMT) | SUR713.025 · Commercial, Medicaid | 13 | Original policy ↗ |
| Intraoperative Neurophysiologic Monitoring (IONM) | MED205.011 · Commercial, Medicaid | 23 | Original policy ↗ |
| Intraoperative Neurophysiology Monitoring (IONM) Policy | CPCP032 · Effective Oct 31, 2025 · Commercial, Medicaid · IL | 21 | Original policy ↗ |
| Intraosseous Radiofrequency Nerve Ablation of the Basivertebral Nerve for the Treatment of Low Back Pain | SUR702.020 · Commercial, Medicaid | 3 | Original policy ↗ |
| Intraurethral Valve Drainage Device for Impaired Detrusor Contractility | DME102.009 · Commercial, Medicaid | 4 | Original policy ↗ |
| Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders | SUR702.016 · Effective Jan 1, 2026 · Commercial, Medicaid | 7 | Original policy ↗ |
| Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease | MED207.104 · Commercial, Medicaid | 12 | Original policy ↗ |
| Intravitreal, Punctum, and Intracameral Implants | OTH903.024 · Commercial, Medicaid | 12 | Original policy ↗ |
| Irreversible Electroporation (IRE) | SUR701.048 · Commercial, Medicaid | 4 | Original policy ↗ |
| Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes | SUR703.057 · Commercial, Medicaid | 10 | Original policy ↗ |
| Isolated Small Bowel Transplant | SUR703.014 · Commercial, Medicaid | 9 | Original policy ↗ |
| Keratoprosthesis | OTH903.030 · Commercial, Medicaid | 3 | Original policy ↗ |
| Kidney Transplant | SUR703.007 · Commercial, Medicaid | 13 | Original policy ↗ |
| KidneyIntelX and KidneyIntelX.dkd Testing | MED207.163 · Commercial, Medicaid | 2 | Original policy ↗ |
| Laboratory Panel Billing | RP021 · Effective Aug 21, 2026 · Commercial, Medicaid · IL | 49 | Original policy ↗ |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease | CPCPLAB035 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 15 | Original policy ↗ |
| Laboratory Testing Investigational Services | MED207.164 · Effective Apr 1, 2026 · Commercial, Medicaid | 28 | Original policy ↗ |
| Lactation Support Services | RP043 · Effective Jul 24, 2026 · Commercial, Medicaid · IL | 17 | Original policy ↗ |
| Lanreotide | RX501.155 · Commercial, Medicaid | 2 | Original policy ↗ |
| Laparoscopic, Percutaneous and Transcervical Techniques for Uterine Fibroid Myolysis | SUR701.033 · Effective Jan 1, 2026 · Commercial, Medicaid | 8 | Original policy ↗ |
| Laser Interstitial Tumor Therapy (LITT) | SUR701.031 · Commercial, Medicaid | 13 | Original policy ↗ |
| Leadless Cardiac Pacemakers | SUR707.030 · Effective Nov 1, 2025 · Commercial, Medicaid | 17 | Original policy ↗ |
| Lecanemab-irmb | RX501.152 · Commercial, Medicaid | 1 | Original policy ↗ |
| Liposuction for Lipedema and Lymphedema | SUR708.003 · Effective Jan 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Liver Transplant and Combined Liver-Kidney Transplant | SUR703.008 · Commercial, Medicaid | 24 | Original policy ↗ |