| Spinal Fusion: Cervical | IV-181 · Effective Sep 28, 2026 · Commercial, Medicaid | 21 | Original policy ↗ |
| Spinal Fusion: Lumbar | IV-87 · Effective Jul 6, 2026 · Commercial, Medicaid | 28 | Original policy ↗ |
| Spinal Unloading Devices: Patient-Operated | VII-59 · Effective Jul 27, 2026 · Commercial, Medicaid | 8 | Original policy ↗ |
| Stem Cell Therapy for Orthopedic Applications | II-142 · Effective Apr 27, 2026 · Commercial, Medicaid | 15 | Original policy ↗ |
| Stem Cell Therapy for Peripheral Arterial Disease | II-151 · Effective Jul 27, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Steroid-Eluting Devices for Maintaining Sinus Ostial Patency | IV-140 · Effective Dec 1, 2025 · Commercial, Medicaid | 4 | Original policy ↗ |
| Sublingual Immunotherapy Drops for Allergy Treatment | II-169 · Effective Oct 27, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Subtalar Arthroereisis | IV-26 · Effective Dec 1, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Surface Electromyography (SEMG) | VII-10 · Effective Jun 29, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Surgery for Groin Pain | IV-173 · Effective Sep 28, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Surgical Treatments of Lymphedema | IV-158 · Effective Jul 27, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Synthetic Cartilage Implants for Metatarsophalangeal Joint Disorders | IV-153 · Effective Aug 31, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Temporomandibular Disorder (TMD): Diagnosis and Selected Treatments | II-07 · Effective Sep 28, 2026 · Commercial, Medicaid | 23 | Original policy ↗ |
| Traction Decompression of the Spine | VII-18 · Effective Jun 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR) for Aortic Stenosis | IV-149 · Effective Jun 29, 2026 · Commercial, Medicaid | 10 | Original policy ↗ |
| Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies | II-190 · Effective Feb 2, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Transcatheter Mitral Valve Repair or Replacement | IV-152 · Effective Jun 29, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Transcatheter Pulmonary Valve Implantation | IV-155 · Effective Jun 29, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Transcatheter Tricuspid Valve Repair or Replacement | IV-184 · Effective Sep 28, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Transcatheter Uterine Artery Embolization | V-10 · Effective Apr 27, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Transcranial Magnetic Stimulation | X-14 · Effective Aug 31, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (GERD) | II-31 · Effective Sep 28, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence | IV-136 · Effective Dec 1, 2025 · Commercial, Medicaid | 3 | Original policy ↗ |
| Tumor Treating Fields Therapy | II-164 · Effective Jun 30, 2025 · Commercial, Medicaid | 3 | Original policy ↗ |
| Ultrasound-Guided High-Intensity Focused Ultrasound Ablation | IV-118 · Effective Mar 2, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Techniques | II-98 · Effective Apr 27, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Vagus Nerve Stimulation | IV-131 · Effective Oct 27, 2025 · Commercial, Medicaid | 23 | Original policy ↗ |
| Ventricular Assist Devices and Total Artificial Hearts | IV-86 · Effective Sep 28, 2026 · Commercial, Medicaid | 12 | Original policy ↗ |
| Vestibular Evoked Myogenic Potential (VEMP) Testing | II-167 · Effective Apr 27, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Virtual Reality | IX-06 · Effective Aug 31, 2026 · Commercial, Medicaid | 8 | Original policy ↗ |
| Viscocanalostomy and Canaloplasty for the Treatment of Glaucoma | IV-144 · Effective Sep 28, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Vitamin D Screening | VI-60 · Effective Aug 31, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Water Vapor Energy Ablation and Waterjet Tissue Ablation for Benign Prostatic Hyperplasia | IV-163 · Effective Mar 2, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Wearable Cardioverter Defibrillators | II-91 · Effective Apr 6, 2026 · Commercial, Medicaid | 6 | Original policy ↗ |
| Wheelchairs - Mobility Assistive Equipment | VII-04 · Effective Aug 31, 2026 · Commercial, Medicaid | 152 | Original policy ↗ |
| Whole Body Dual X-Ray Absorptiometry (DXA) to Determine Body Composition | V-28 · Effective Aug 31, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Wireless Capsule Endoscopy | V-12 · Effective Jul 27, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Wireless Gastric Motility Monitoring | II-134 · Effective Jun 29, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Wound Healing: Electrostimulation and Electromagnetic Therapy | II-85 · Effective Sep 28, 2026 · Commercial, Medicaid | 7 | Original policy ↗ |
| Wound Healing: Non-Contact Ultrasound Treatment | II-88 · Effective Feb 2, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
