| Lumbar Spinal Fusion | SUR712.036 · Effective Jan 1, 2026 · Commercial, Medicaid | 37 | Original policy ↗ |
| Lung and Lobar Lung Transplant | SUR703.010 · Commercial, Medicaid | 10 | Original policy ↗ |
| Lyme Disease Testing | RPLAB044 · Effective Sep 4, 2026 · Commercial, Medicaid · TX | 9 | Original policy ↗ |
| Lysis of Epidural Adhesions | SUR712.024 · Commercial, Medicaid | 5 | Original policy ↗ |
| Magnetic Resonance-Guided Focused Ultrasound | SUR701.022 · Commercial, Medicaid | 6 | Original policy ↗ |
| Management of Hereditary Angioedema (HAE) with C1 Esterase Inhibitor, Human and Ecallantide | RX504.013 · Effective Jan 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Manipulation Under Anesthesia | THE803.016 · Effective Sep 15, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Mastopexy | SUR716.010 · Commercial, Medicaid | 1 | Original policy ↗ |
| Measurement of Serum Antibodies to Selected Biologic Agents | MED207.153 · Effective Jan 1, 2026 · Commercial, Medicaid | 6 | Original policy ↗ |
| Medical Management of Sleep Related Breathing Disorders | MED204.006 · Effective May 15, 2026 · Commercial, Medicaid | 37 | Original policy ↗ |
| Medical Policies Moving to MCG Guidelines | ADM1001.036 · Commercial, Medicaid | 303 | Original policy ↗ |
| Medical Record Documentation | CPCP029 · Effective Oct 31, 2025 · Commercial, Medicaid · TX | — | Original policy ↗ |
| Medicare Advantage Value-Based Care Provider Manual | 771381.0126 · Medicaid · TX | 13 | Original policy ↗ |
| Medications in behavioral health care: Quick reference on potential side effects | 764828.0126 · Commercial, Medicaid · TX | — | Original policy ↗ |
| Meniscal Allografts and Other Meniscal Implants | SUR705.034 · Effective Jul 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Mepolizumab | RX501.080 · Commercial, Medicaid | 4 | Original policy ↗ |
| Micronutrient Testing | RPLAB029 · Effective Sep 4, 2026 · Commercial, Medicaid · TX | 26 | Original policy ↗ |
| Microwave Tumor Ablation | SUR701.038 · Effective Dec 15, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine | RAD601.041 · Effective Sep 1, 2026 · Commercial, Medicaid | 13 | Original policy ↗ |
| Minimally Invasive Fixation/Fusion of the Sacroiliac Joint | SUR705.033 · Effective Nov 1, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Mirikizumab-mrkz | RX501.168 · Commercial, Medicaid | 1 | Original policy ↗ |
| Modifier Reference Policy | CPCP023 · Effective Oct 31, 2025 · Commercial, Medicaid · TX | 1 | Original policy ↗ |
| Modifier Reference Policy | RP023 · Effective Oct 19, 2026 · Commercial, Medicaid · TX | 3 | Original policy ↗ |
| Multiple Surgical Procedures – Professional Provider | RP015 · Effective Apr 10, 2026 · Commercial, Medicaid · TX | — | Original policy ↗ |
| Myocardial Strain Imaging | RAD601.069 · Commercial, Medicaid | 3 | Original policy ↗ |
| Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure | RAD604.012 · Commercial, Medicaid | 4 | Original policy ↗ |
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | DME104.001 · Effective Jun 15, 2026 · Commercial, Medicaid | 48 | Original policy ↗ |
| Narsoplimab-wuug | RX501.193 · Commercial, Medicaid | 1 | Original policy ↗ |
| Natalizumab and Associated Biosimilar(s) | RX501.059 · Effective May 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Negative Pressure Wound Therapy in the Outpatient Setting | DME101.036 · Commercial, Medicaid | 13 | Original policy ↗ |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | RP004 · Effective May 22, 2026 · Commercial, Medicaid · TX | — | Original policy ↗ |
| Nerve Fiber Density Testing | CPCPLAB064 · Effective May 1, 2026 · Commercial, Medicaid · TX | 7 | Original policy ↗ |
| Nerve Graft with Radical Prostatectomy | SUR710.019 · Commercial, Medicaid | 9 | Original policy ↗ |
| Neuralgia Inducing Cavitational Osteonecrosis (NICO) | SUR705.028 · Commercial, Medicaid | 12 | Original policy ↗ |
| Nipocalimab-aahu | RX501.188 · Commercial, Medicaid | 1 | Original policy ↗ |
| Non-Invasive Measurement of Central Blood Pressure (cBP) | MED202.070 · Effective Sep 15, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | RP028 · Effective Sep 11, 2026 · Commercial, Medicaid · TX | 5 | Original policy ↗ |
| Noncontact Normothermic Wound Therapy (NNWT) | DME101.050 · Commercial, Medicaid | 3 | Original policy ↗ |
| Noncontact Ultrasound Treatment for Wounds | DME101.044 · Commercial, Medicaid | 1 | Original policy ↗ |
| Nonpharmacologic Treatment of Rosacea | THE801.030 · Effective May 1, 2026 · Commercial, Medicaid | 19 | Original policy ↗ |
| Nonwearable Automatic External Defibrillators | DME101.021 · Commercial, Medicaid | 1 | Original policy ↗ |
| Nusinersen | RX501.086 · Effective Jan 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Nutritional Support | MED201.011 · Commercial, Medicaid | 66 | Original policy ↗ |
| Obinutuzumab | RX501.187 · Commercial, Medicaid | 1 | Original policy ↗ |
| Observation Services Policy | CPCP001 · Effective Dec 22, 2025 · Commercial, Medicaid · TX | 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 ↗ |
