| DRG Newborn Inpatient Stays – Facility | C-18002 · Effective Dec 18, 2025 · Commercial · GA, IN, KY, WI | — | Original policy ↗ |
| Drug Screen Testing | G-19001 · Effective Nov 14, 2025 · Medicaid · OH | — | Original policy ↗ |
| Drug Screen Testing | G-19001 · Effective Dec 1, 2026 · Medicaid · IN | — | Original policy ↗ |
| Drug Screen Testing | G-19001 · Effective Nov 14, 2025 · Medicaid · NV | — | Original policy ↗ |
| Drug Screen Testing - Professional | C-12004 · Effective Oct 1, 2026 · Commercial · CA | 17 | Original policy ↗ |
| Drug Screen Testing – Professional | C-12004 · Effective Oct 23, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 17 | Original policy ↗ |
| Drug Screen Testing – Professional | C-12004 · Effective Mar 1, 2025 · Commercial · VA | 17 | Original policy ↗ |
| Drugs and Devices Requiring Procedures – Facility | C-26001 · Effective Jul 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Drugs and Devices Requiring Procedures – Facility | C-26001 · Effective Oct 1, 2026 · Commercial · CA | — | Original policy ↗ |
| Duplicate or Subsequent Services on the Same Date of Service | G-06032 · Effective May 22, 2024 · Medicaid · OH | — | Original policy ↗ |
| Duplicate or Subsequent Services on the Same Date of Service | G-06032 · Effective May 22, 2024 · Medicaid · IN | — | Original policy ↗ |
| Duplicate or Subsequent Services on the Same Date of Service | G-06032 · Effective May 22, 2024 · Medicaid · NV | — | Original policy ↗ |
| Durable Medical Equipment (Rent to Purchase) | G-06052 · NY | — | Original policy ↗ |
| Durable Medical Equipment (Rent to Purchase) | G-06052 · ME | — | Original policy ↗ |
| Durable Medical Equipment (Rent to Purchase) | G-06052 · Effective Oct 6, 2025 · Medicaid · OH | — | Original policy ↗ |
| Durable Medical Equipment (Rent to Purchase) | G-06052 · Effective Oct 6, 2025 · Medicaid · IN | — | Original policy ↗ |
| Durable Medical Equipment (Rent to Purchase) | G-06052 · Effective Oct 6, 2025 · Medicaid · NV | — | Original policy ↗ |
| Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) | G-06049 · Effective Jul 21, 2025 · Medicaid · OH | — | Original policy ↗ |
| Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) | G-06049 · Effective Jul 21, 2025 · Medicaid · IN | — | Original policy ↗ |
| Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) | G-06049 · Effective Jul 21, 2025 · Medicaid · NV | — | Original policy ↗ |
| Edinburgh Postnatal Depression Scale (EPDS) | Commercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI | — | Original policy ↗ |
| Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | DME.00011 · Commercial | 15 | Original policy ↗ |
| Electronic ID Cards Dental Quick Reference Guide | Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · CA | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · CO | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · CT | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · ME | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · NV | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · NH | — | Original policy ↗ |
| Electronic Member ID Cards Quick Reference Guide | Commercial · VA | — | Original policy ↗ |
| Electronic Member ID Cards: Dental Quick Reference Guide | Commercial · CA | — | Original policy ↗ |
| Eligible Billed Charges | G-06001 · Effective Nov 4, 2024 · Medicaid · OH | — | Original policy ↗ |
| Eligible Billed Charges | G-06001 · Effective Nov 4, 2024 · Medicaid · NV | — | Original policy ↗ |
| Emergency Department Leveling of Evaluation and Management Services | G-19002 · Effective Jan 16, 2024 · Medicaid · NV | — | Original policy ↗ |
| Emergency Department Protocol for SIU Review | Commercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA, WI | 10 | Original policy ↗ |
| Emergency Department: Leveling of Evaluation and Management Services | G-19002 · Effective Nov 1, 2026 · Medicaid · OH | — | Original policy ↗ |
| Emergency Department: Leveling of Evaluation and Management Services – Facility | C-13001 · Effective Jan 1, 2021 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Emergency Department: Leveling of Evaluation and Management Services- Facility | C-13001 · Effective Jul 1, 2024 · Commercial · CA | — | Original policy ↗ |
| Emergency Room Transfers – Facility | C-20006 · Effective Jul 17, 2024 · Commercial · CO, CT, GA, IN, KY, MO, NV, OH, WI | 5 | Original policy ↗ |
| Emergency Room Transfers – Facility | C-20006 · Effective Jan 1, 2026 · Commercial · CA | 5 | Original policy ↗ |
| Emergency Services: Nonparticipating Providers and Facilities | G-06092 · Effective Apr 29, 2022 · Medicaid · NV | — | Original policy ↗ |
| Encounter Utilization Quality Tracking | Commercial · CA | — | Original policy ↗ |
| Enhancements made to avoidable ER program | Commercial · IN, MO, OH | — | Original policy ↗ |
| Enrollment and revalidation requirements Medicaid participation | Medicaid · NV | — | Original policy ↗ |
| Escalation Contact List | Commercial · NV | — | Original policy ↗ |
| Escalation Process | Commercial · NH | — | Original policy ↗ |
| Example of Cardiology Referral Preparedness Tool | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Example of Endocrinology Referral Preparedness Tool | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Example of OB/GYN Referral Preparedness Tool | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Facility and Professional Provider Manual (For Commercial Products) | Commercial · GA | 10 | Original policy ↗ |
