| Observation Services Policy | CPCP001 · Effective Dec 22, 2025 · Commercial, Medicaid · IL | 10 | Original policy ↗ |
| Occipital Nerve Stimulation | SUR712.033 · Commercial, Medicaid | 19 | Original policy ↗ |
| Ocrelizumab or Ocrelizumab and Hyaluronidase-ocsq | RX501.085 · Commercial, Medicaid | 2 | Original policy ↗ |
| Octreotide acetate | RX501.156 · Commercial, Medicaid | 2 | Original policy ↗ |
| Omalizumab | RX501.058 · Commercial, Medicaid | 1 | Original policy ↗ |
| Onasemnogene abeparvovec-brve | RX501.186 · Effective Jul 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Onasemnogene abeparvovec-xioi | RX501.104 · Effective Jan 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus | THE801.029 · Commercial, Medicaid | 5 | Original policy ↗ |
| Oncology Medications | RX502.061 · Effective Jul 1, 2026 · Commercial, Medicaid | 175 | Original policy ↗ |
| Onychomycosis Testing | RPLAB068 · Effective Sep 4, 2026 · Medicaid · IL | — | Original policy ↗ |
| Ophthalmologic Techniques That Evaluate the Posterior Segment for Glaucoma | OTH903.022 · Effective Jan 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Optical Coherence Tomography of the Anterior Eye Segment | OTH903.021 · Commercial, Medicaid | 1 | Original policy ↗ |
| Oral Cancer Screening and Testing | CPCPLAB032 · Effective Jan 1, 2026 · Commercial, Medicaid · IL | 8 | Original policy ↗ |
| Oral Cancer Screening and Testing | RPLAB032 · Effective Dec 4, 2026 · Commercial, Medicaid · IL | 9 | Original policy ↗ |
| Organ and Tissue Transplantation (General Donor and Recipient Information) | SUR703.001 · Effective Jan 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Orthognathic Surgery | SUR705.030 · Commercial, Medicaid | 32 | Original policy ↗ |
| Orthopedic Applications of Platelet-Rich Plasma | RX501.101 · Effective Sep 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow) | SUR703.051 · Commercial, Medicaid | 11 | Original policy ↗ |
| Outpatient Facility Service(s) Overlapping During an Inpatient Stay | RP039 · Effective Jun 8, 2026 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Outpatient Pulmonary Rehabilitation | THE803.025 · Effective Sep 15, 2026 · Commercial, Medicaid | 12 | Original policy ↗ |
| Outpatient Services Prior to an Inpatient Admission | RP038 · Effective May 22, 2026 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Pancreatic Enzyme Testing for Acute Pancreatitis | RPLAB047 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 8 | Original policy ↗ |
| Parathyroid Hormone, Phosphorous, Calcium and Magnesium Testing | RPLAB055 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 7 | Original policy ↗ |
| Paravertebral Facet Injection Procedure Billing & Coding Policy | CPCP036 · Effective Nov 21, 2025 · Commercial, Medicaid · IL | 16 | Original policy ↗ |
| Pathogen Panel Testing | CPCPLAB045 · Effective Apr 24, 2026 · Commercial, Medicaid · IL | 55 | Original policy ↗ |
| Pathogen Panel Testing | RPLAB045 · Effective Dec 4, 2026 · Commercial, Medicaid · IL | 59 | Original policy ↗ |
| Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty | SUR705.037 · Effective Sep 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Pediatric Preventive Screening | RPLAB016 · Effective Sep 4, 2026 · Commercial, Medicaid · IL | 18 | Original policy ↗ |
| Pegloticase | RX501.120 · Commercial, Medicaid | 1 | Original policy ↗ |
| Pelvic Floor Stimulation as a Treatment of Urinary or Fecal Incontinence | DME101.037 · Commercial, Medicaid | 5 | Original policy ↗ |
| Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel Syndrome | MED201.055 · Commercial, Medicaid | 2 | Original policy ↗ |
| Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy | MED205.032 · Effective Oct 15, 2025 · Commercial, Medicaid | 4 | Original policy ↗ |
| Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty | SUR712.023 · Commercial, Medicaid | 2 | Original policy ↗ |
| Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation | SUR701.009 · Effective Jul 15, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease | SUR707.034 · Effective Jan 1, 2026 · Commercial, Medicaid | 78 | Original policy ↗ |
| Perinatal Wellness Guidelines | 227423.0925 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Perinatal Wellness Guidelines (Spanish) | 227424.0925 · Commercial, Medicaid · IL | — | Original policy ↗ |
| Peripheral Subcutaneous Field Stimulation | MED205.036 · Commercial, Medicaid | 1 | Original policy ↗ |
| Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux (VUR) | SUR710.022 · Commercial, Medicaid | 4 | Original policy ↗ |
| Photodynamic Therapy for Choroidal Neovascularization | OTH903.015 · Effective Dec 15, 2025 · Commercial, Medicaid | 9 | Original policy ↗ |
| Phototherapeutic Keratectomy | SUR713.023 · Commercial, Medicaid | 5 | Original policy ↗ |
| Phrenic Nerve Stimulation for Central Sleep Apnea | SUR701.042 · Commercial, Medicaid | 13 | Original policy ↗ |
| Physical Medicine and Rehabilitation Services | CPCP040 · Effective Nov 7, 2025 · Commercial, Medicaid · IL | 22 | Original policy ↗ |
| Physical Therapy (PT) and Occupational Therapy (OT) Services | THE803.010 · Commercial, Medicaid | 69 | Original policy ↗ |
| Plugs for Anal Fistula Repair | SUR709.032 · Commercial, Medicaid | 1 | Original policy ↗ |
| Pneumatic Compression Devices | RP022 · Effective Jul 17, 2026 · Commercial, Medicaid · IL | 18 | Original policy ↗ |
| Point-of-Care Ultrasound Examination Policy | CPCP030 · Effective Dec 19, 2025 · Commercial, Medicaid · IL | 59 | Original policy ↗ |
| Polysomnography for Non-Respiratory Sleep Disorders | MED201.049 · Commercial, Medicaid | 6 | Original policy ↗ |
| Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis | MED202.073 · Commercial, Medicaid | 16 | Original policy ↗ |
| Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities | DME103.008 · Effective Sep 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
