| Digital Therapeutics for Amblyopia | II-288 · Effective Dec 1, 2025 · Commercial, Medicaid | 6 | Original policy ↗ |
| Digital Therapeutics for Diagnostic Applications | II-289 · Effective Oct 27, 2025 · Commercial, Medicaid | 3 | Original policy ↗ |
| Donor Lymphocyte Infusion and Hematopoietic Progenitor Cell (HPC) Boost | II-126 · Effective Jun 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Drug Testing for Substance Use Disorder and Chronic Pain Management | VI-47 · Effective Dec 1, 2025 · Commercial, Medicaid | 19 | Original policy ↗ |
| Dry Needling | VII-67 · Effective Jun 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Dynamic Spinal Visualization and Vertebral Motion Analysis | V-17 · Effective Jun 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Dynamic Spine Stabilization | IV-52 · Effective Feb 2, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Electrical/Electromagnetic Stimulation for Treatment of Arthritis | VII-24 · Effective Jun 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Electroconvulsive Therapy | X-46 · Effective Feb 2, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Electromagnetic Navigational Bronchoscopy | II-132 · Effective Feb 2, 2026 · Commercial, Medicaid | 6 | Original policy ↗ |
| Endoscopic Radiofrequency Ablation or Cryoablation for Barrett's Esophagus | II-94 · Effective Sep 29, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Endothelial Keratoplasty | IV-150 · Effective Jun 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Endovascular Stent Grafts for Abdominal Aortic Aneurysms | IV-156 · Effective Aug 31, 2026 · Commercial, Medicaid | 15 | Original policy ↗ |
| Endovascular Stent Grafts for Disorders of the Thoracic Aorta | IV-157 · Effective Aug 31, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Endovascular Therapies for Extracranial Vertebral Artery Disease | IV-141 · Effective Mar 30, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Esophageal pH Monitoring | VII-64 · Effective Jun 29, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Evaluation Process for New FDA-Approved Medical Drugs or Medical Drug Indications | II-174 · Effective Mar 30, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Expanded Cardiovascular Risk Panels | VI-51 · Effective Dec 1, 2025 · Commercial, Medicaid | 6 | Original policy ↗ |
| Expanded Gastrointestinal Testing Panels | VI-59 · Effective Jun 29, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| External Upper Limb Tremor Stimulator Therapy | II-291 · Effective Feb 2, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Extracorporeal Photopheresis | II-194 · Effective Mar 30, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Extracorporeal Shock Wave Treatment for Musculoskeletal Conditions and Soft Tissue Repair | II-11 · Effective Mar 2, 2026 · Commercial, Medicaid | 7 | Original policy ↗ |
| Eyelid Thermal Pulsation | IX-05 · Effective Jun 1, 2026 · Commercial, Medicaid | 7 | Original policy ↗ |
| Facet Arthroplasty | IV-110 · Effective Feb 2, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Fecal Microbiota | II-198 · Effective Mar 30, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Fetal Surgery for Prenatally Diagnosed Malformations | IV-175 · Effective Jun 1, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Fractional Flow Reserve (FFR) | IV-182 · Effective Jun 29, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Functional Endoscopic Sinus Surgery (FESS) | IV-174 · Effective Jun 29, 2026 · Commercial, Medicaid | 11 | Original policy ↗ |
| Functional Neuromuscular Electrical Stimulation Devices in the Home Setting | VII-11 · Effective May 4, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Gastric Electrical Stimulation | IV-28 · Effective Mar 30, 2026 · Commercial, Medicaid | 16 | Original policy ↗ |
| Gender Affirming Procedures | IV-123 · Effective Apr 27, 2026 · Commercial, Medicaid | 141 | Original policy ↗ |
| Genetic Cancer Susceptibility Panels | VI-56 · Effective Aug 31, 2026 · Commercial, Medicaid | 19 | Original policy ↗ |
| Genetic Testing for Hereditary Breast and/or Ovarian Cancer | VI-16 · Effective May 4, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Genetic Testing for Inherited Non-Cancer Conditions | VI-09 · Effective Jun 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Gynecomastia Surgery | IV-71 · Effective Sep 28, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Hair Analysis | VI-06 · Effective Mar 30, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Helicobacter Pylori (H. Pylori) Serology Testing | II-109 · Effective Mar 30, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Acute Lymphoblastic Leukemia | II-118 · Effective Dec 1, 2025 · Commercial, Medicaid | 20 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia | II-115 · Effective Jan 5, 2026 · Commercial, Medicaid | 20 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Autoimmune Disease | II-121 · Effective Dec 1, 2025 · Commercial, Medicaid | 20 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Central Nervous System (CNS) Embryonal Tumors and Ependymoma | II-130 · Effective Mar 2, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma | II-122 · Effective Apr 27, 2026 · Commercial, Medicaid | 20 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia | II-136 · Effective Apr 27, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Genetic Diseases and Acquired Anemias | II-129 · Effective Feb 2, 2026 · Commercial, Medicaid | 19 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma | II-135 · Effective Feb 2, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Miscellaneous Solid Tumors in Adults | II-123 · Effective Mar 30, 2026 · Commercial, Medicaid | 20 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Multiple Myeloma and POEMS Syndrome | II-138 · Effective Jan 5, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndrome and Myeloproliferative Neoplasms | II-133 · Effective Mar 30, 2026 · Commercial, Medicaid | 17 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Non-Hodgkin Lymphoma | II-117 · Effective Jul 27, 2026 · Commercial, Medicaid | 20 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Primary Amyloidosis | II-119 · Effective Jun 29, 2026 · Commercial, Medicaid | 20 | Original policy ↗ |
