| 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-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 ↗ |
| Elivaldogene autotemcel | RX501.149 · Effective Jan 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus | SUR709.033 · Effective Jan 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Endoscopic Ultrasound-Guided Direct Hepatic Portosystemic Pressure Gradient Measurement | SUR701.043 · Commercial, Medicaid | 1 | Original policy ↗ |
| Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms) | SUR701.027 · Effective Dec 1, 2025 · Commercial, Medicaid | 16 | Original policy ↗ |
| Endovascular Stent Grafts for Disorders of the Thoracic Aorta | MED202.057 · Effective May 1, 2026 · Commercial, Medicaid | 12 | Original policy ↗ |
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | RX501.067 · Commercial, Medicaid | 20 | Original policy ↗ |
| Eptinezumab-jjmr | RX501.124 · Effective Apr 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Erythropoiesis-Stimulating Agents (ESAs) | RX501.069 · Effective Jan 1, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Esketamine Nasal Spray | RX501.105 · Commercial, Medicaid | 5 | Original policy ↗ |
| Esophageal pH Monitoring | MED201.005 · Commercial, Medicaid | 5 | Original policy ↗ |
| Etranacogene dezaparvovec-drlb | RX501.151 · Effective Jan 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Etuvetidigene autotemcel | RX501.191 · Commercial, Medicaid | 1 | Original policy ↗ |
| Evinacumab-dgnb | RX501.136 · Commercial, Medicaid | 1 | Original policy ↗ |
| External Counterpulsation (ECP) Therapy for Severe Angina | MED202.050 · Effective May 15, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Extracorporeal Photopheresis | THE801.026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions | SUR705.018 · Effective Nov 1, 2025 · Commercial, Medicaid | 6 | Original policy ↗ |
| Extracranial Carotid Angioplasty or Stenting | SUR701.028 · Commercial, Medicaid | 5 | Original policy ↗ |
| Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome | OTH903.025 · Effective Jul 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Facet Arthroplasty | SUR712.034 · Commercial, Medicaid | 2 | Original policy ↗ |
| Facet Joint and Sacroiliac Joint Denervation | SUR702.017 · Commercial, Medicaid | 6 | Original policy ↗ |
| Facet Joint Injections | SUR702.015 · Commercial, Medicaid | 13 | Original policy ↗ |
| Faricimab-svoa | OTH903.044 · Commercial, Medicaid | 2 | Original policy ↗ |
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | RX501.087 · Commercial, Medicaid | 6 | Original policy ↗ |
| Fecal Analysis in the Diagnosis of Intestinal Dysbiosis | MED207.118 · Effective May 15, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Fecal Microbiota Transplantation (FMT) | SUR703.049 · Commercial, Medicaid | 4 | Original policy ↗ |
| Fetal Surgery for Prenatally Diagnosed Malformations | SUR701.016 · Commercial, Medicaid | 13 | Original policy ↗ |
| Focal Treatments for Prostate Cancer | SUR717.004 · Commercial, Medicaid | 6 | Original policy ↗ |
| Functional Neuromuscular Electrical Stimulation | MED201.033 · Effective Aug 1, 2025 · Commercial, Medicaid | 7 | Original policy ↗ |
| Gastrointestinal Pathogen Panels | MED207.155 · Commercial, Medicaid | 5 | Original policy ↗ |
| Gender Assignment Surgery and Gender Reassignment Surgery with Related Services | SUR717.001 · Commercial, Medicaid | 127 | Original policy ↗ |
| Gene Therapies for Metachromatic Leukodystrophy | RX501.171 · Effective Dec 15, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Gene Therapies for Sickle Cell Disease | RX501.167 · Effective Sep 15, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Gene Therapies for Thalassemia | RX501.166 · Effective Sep 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Gene Therapies for Treatment of Wounds in Dystrophic Epidermolysis Bullosa | RX501.164 · Effective Jun 15, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
