| 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 ↗ |
| 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 3, 2026 · Commercial, Medicaid · NM | 6 | Original policy ↗ |
| Diabetes Mellitus Testing | RPLAB004 · Effective Dec 4, 2026 · Commercial, Medicaid · NM | 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 · NM | 51 | Original policy ↗ |
| Diagnosis of Obstructive Sleep Apnea Syndrome | MED204.005 · Effective Jan 1, 2026 · Commercial, Medicaid | 14 | Original policy ↗ |
| Diagnostic Testing of Common Sexually Transmitted Infections | RPLAB051 · Effective Sep 4, 2026 · Commercial, Medicaid · NM | 88 | Original policy ↗ |
| Diagnostic Testing of Influenza | CPCPLAB033 · Effective Jan 15, 2025 · Commercial, Medicaid · NM | 9 | Original policy ↗ |
| Diagnostic Testing of Iron Homeostasis & Metabolism | CPCPLAB008 · Effective May 1, 2026 · Commercial, Medicaid · NM | 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 · NM | 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 ↗ |
| Early and Periodic Screening, Diagnostic and Treatment Clinical Practice and Billing Guideline | 489951.0725 · Medicaid · NM | 34 | 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 ↗ |
| Emergency Department Services Evaluation and Management (E/M) Coding – Professional Services | CPCP042 · Effective Nov 14, 2025 · Commercial, Medicaid · NM | 5 | Original policy ↗ |
| Emergency Department Services Evaluation and Management - E/M Coding – Facility Services | CPCP003 · Effective Oct 6, 2025 · Commercial, Medicaid · NM | 14 | 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 ↗ |
| English | 81641.0925 · Commercial, Medicaid · NM | — | Original policy ↗ |
| English | 81522.0925 · Commercial, Medicaid · NM | — | Original policy ↗ |
| English | 477196.0925 · Commercial, Medicaid · NM | — | Original policy ↗ |
