| Actigraphy | Effective Mar 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Add-On Code | RP-P-100X · Effective Oct 30, 2006 · Commercial, Medicaid | 14 | Original policy ↗ |
| Add-On Code | RP-F-595X · Effective Nov 1, 2025 · Commercial, Medicaid | 31 | Original policy ↗ |
| Add-on Code- Facility | RP-F-555M · Effective Sep 1, 2021 · Commercial, Medicaid | — | Original policy ↗ |
| After Hours and Weekend Care | RP-P-105X · Effective Dec 1, 2005 · Commercial, Medicaid | 6 | Original policy ↗ |
| Air Conduction Hearing Aids (Wearable and Bone Anchored) | Effective Mar 1, 2026 · Commercial, Medicaid | 71 | Original policy ↗ |
| Ambulance | RP-P-110X · Effective Nov 15, 2014 · Commercial, Medicaid | — | Original policy ↗ |
| Amino Acid-Based Elemental Formula | Effective May 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Anesthesia | RP-P-115X · Effective Oct 1, 1998 · Commercial, Medicaid | 24 | Original policy ↗ |
| Assistant Surgeon | RP-P-120X · Effective Apr 1, 1999 · Commercial, Medicaid | — | Original policy ↗ |
| Autologous Blood-Derived Products (Platelet-Rich Plasma, Autologous Conditioned Serum, Autologous Whole Blood) | Effective Aug 1, 2026 · Commercial, Medicaid | 6 | Original policy ↗ |
| Automated, Non-Invasive Nerve Conduction Velocity (NCV) Testing | Effective Sep 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Bilateral Procedures | RP-P-125X · Effective Apr 1, 1999 · Commercial, Medicaid | — | Original policy ↗ |
| Bioimpedance Spectroscopy (BIS) and Bioelectrical Impedance Analysis (BIA) | Effective Sep 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Birth Centers (Free-Standing) | Effective Mar 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Blood Coagulation Home Testing Devices | Effective May 1, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Breast Ductal Lavage | Effective Oct 1, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Bronchial Thermoplasty for Treatment of Asthma | Effective Feb 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Bundled Services | RP-P-130X · Effective Jun 1, 2007 · Commercial, Medicaid | 1 | Original policy ↗ |
| Cala Trio Therapy for Essential Tremor | Effective Jun 19, 2023 · Commercial, Medicaid | 1 | Original policy ↗ |
| Cardiac Event Monitors | Effective Sep 1, 2026 · Commercial, Medicaid | 32 | Original policy ↗ |
| Cardiac Rehabilitation in the Outpatient Setting | Effective May 1, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Care Plan Oversight | RP-P-135X · Effective Sep 1, 1997 · Commercial, Medicaid | 2 | Original policy ↗ |
| Carotid Intima-Media Thickness Measurement | Effective Jul 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| CCI Editing - Professional | RP-P-140X · Effective Nov 15, 2009 · Commercial, Medicaid | — | Original policy ↗ |
| CCI Editing, Facility | RP-F-560M · Effective Sep 1, 2021 · Commercial | — | Original policy ↗ |
| Cell Therapy for the Treatment of Cardiac Disease | Effective Oct 1, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Chemiluminescent Testing (ViziLite®) for Oral Cancer Screening | Effective Apr 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Chemoembolization for Hepatic Tumors | Effective Oct 1, 2025 · Commercial, Medicaid | 3 | Original policy ↗ |
| Chiropractic Services | Effective Aug 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Chronic Rhinitis: Cryoablation, Radiofrequency Ablation, and Laser Ablation, Office-Based | Effective Jul 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| CLEAR Institute Scoliosis Treatment Protocols | Effective Apr 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Clinical Trial Participation | Effective Mar 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Co-Surgeon/Team Surgeon | RP-P-150X · Effective Oct 1, 1999 · Commercial, Medicaid | — | Original policy ↗ |
| Cognitive Rehabilitation/Remediation | Effective Nov 1, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Collagen Cross Links Tests as Markers of Bone Turnover | Effective Sep 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Colorectal Cancer Screening (Preventative & Diagnostic) | Effective Sep 1, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Compounded Bio-Identical Hormone Replacement Therapy (BHRT) | Effective May 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Compounded Sublingual, Oral, or Intranasal Allergenic Extracts for Allergy Diagnosis and/or Immunotherapy | Effective Apr 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Computerized Dynamic Posturography | Effective Jan 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Confocal Laser Endomicroscopy for Barrett’s Esophagus | Effective Feb 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Contrast and Radiopharmaceutical Materials | RP-P-145X · Effective Nov 14, 2010 · Commercial, Medicaid | 3 | Original policy ↗ |
| Corneal Cross-Linking Policy Name; Corneal Cross-Linking | Effective Jul 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| COVID-19 Testing | RP-PF-435X · Effective Feb 4, 2020 · Commercial, Medicaid | 28 | Original policy ↗ |
| Cranial Electrotherapy Stimulation (CES) | Effective Nov 1, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Craniosacral Therapy | Effective Jul 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Cytotoxic Testing for Allergy Diagnosis | Effective Feb 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Deep Brain Stimulation (DBS) and Responsive Neuromodulation (RNS) | Effective Mar 1, 2026 · Commercial, Medicaid | 11 | Original policy ↗ |
| Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency (CCSVI) in Multiple Sclerosis | Effective Feb 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Discarded Drugs and Biologicals | RP-FP- 590X · Effective Oct 1, 2025 · Commercial, Medicaid | — | Original policy ↗ |
