| Discontinued Procedure | RP-P-160X · Effective Jan 1, 1997 · Commercial, Medicaid | — | Original policy ↗ |
| Drug Eluting Sinus Stents, Bioabsorbable | Effective Jul 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Durable Medical Equipment (DME) | Effective Jun 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
| Elastography (Ultrasound, Acoustic Radiation Force Impulse Imaging, Shear Wave Elastography) | Effective Jul 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Electric Cell-Signaling Treatment (e.g., neoGEN® System, Sanexas Intl.) | Effective May 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Electric Tumor Treatment Fields (Optune®) | Effective Mar 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Electrical or Electromagnetic Stimulation for Healing of Chronic Wounds | Effective Aug 1, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Emergency Department Evaluation and Management Codes | RP-F-575X · Effective Apr 1, 2025 · Commercial, Medicaid | 7 | Original policy ↗ |
| Endoscopic Balloon Sinuplasty Ostial Dilation for Treatment of Chronic Sinusitis | Effective Jun 1, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Endoscopic Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD) | Effective Jan 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Endoscopic Radiofrequency Ablation for Barrett’s Esophagus | Effective Nov 1, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Enhanced External Counterpulsation (EECP) | Effective Mar 20, 2023 · Commercial, Medicaid | 1 | Original policy ↗ |
| Epidural Lysis of Adhesions | Effective Jan 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Eustachian Tube Balloon Dilation | Effective Apr 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Exhaled Breath Tests for Asthma and Other Inflammatory Pulmonary Conditions: Exhaled Nitric Oxide Breath Test and Exhaled Breath Condensate pH Measurement | Effective Jun 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Extracorporeal Magnetic Stimulation for the Treatment of Urinary Incontinence | Effective Sep 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Extracorporeal Photopheresis (Photochemotherapy) | Effective Nov 1, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Indications and Soft Tissue Injuries | Effective Mar 1, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Eye-Movement Analysis without Spatial Calibration (e.g., EyeBOX® system) | Effective Nov 1, 2025 · Commercial, Medicaid | 1 | Original policy ↗ |
| Fecal Calprotectin Testing | Effective Aug 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Female External Urinary Catheters for Urinary Incontinence (e.g., PureWick, PrimaFit) | Effective Nov 20, 2023 · Commercial, Medicaid | 2 | Original policy ↗ |
| Food Allergy / Intolerance Testing (in vitro) | Effective Nov 18, 2019 · Commercial, Medicaid | 5 | Original policy ↗ |
| Foot Care | Effective Feb 1, 2026 · Commercial, Medicaid | 8 | Original policy ↗ |
| From-To Date | RP-P-165X · Effective Apr 15, 2010 · Commercial, Medicaid | — | Original policy ↗ |
| Functional Electrical Stimulation (FES), Upper and Lower Limb | Effective Oct 1, 2025 · Commercial, Medicaid | 4 | Original policy ↗ |
| Gastric Electrical Stimulation | Effective Jan 1, 2026 · Commercial, Medicaid | 2 | Original policy ↗ |
| Gastrointestinal Monitoring System (SmartPill®) | Effective Jan 1, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |
| Genetic and Molecular Laboratory Testing | RP-PF-570X · Effective Dec 1, 2022 · Commercial, Medicaid | 1 | Original policy ↗ |
| Genetic Testing - Reproductive Testing: Fertility | Effective Jul 1, 2026 · Commercial, Medicaid | 10 | Original policy ↗ |
| Genetic Testing - Reproductive Testing: Prenatal Diagnosis | Effective Jul 1, 2026 · Commercial, Medicaid | 29 | Original policy ↗ |
| Genetic Testing - Reproductive Testing: Prenatal Screening | Effective Jul 1, 2026 · Commercial, Medicaid | 24 | Original policy ↗ |
| Genetic Testing - Specialty Testing: Gastroenterology | Effective Jul 1, 2026 · Commercial, Medicaid | 26 | Original policy ↗ |
| Genetic Testing - Specialty Testing: Identity and Forensics | Effective Jul 1, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Genetic Testing - Specialty Testing: Multisystem Genetic Conditions | Effective Jul 1, 2026 · Commercial, Medicaid | 57 | Original policy ↗ |
| Genetic Testing - Specialty Testing: Toxicology and Pharmacogenomics | Effective Jul 1, 2026 · Commercial, Medicaid | 53 | Original policy ↗ |
| Genetic Testing – Oncology Testing - Cancer Screening and Surveillance | Effective Jul 1, 2026 · Commercial, Medicaid | 24 | Original policy ↗ |
| Genetic Testing – Oncology Testing: Algorithmic Assays | Effective Jul 1, 2026 · Commercial, Medicaid | 106 | Original policy ↗ |
| Genetic Testing – Oncology Testing: Hematologic Malignancy Molecular Diagnostics | Effective Jul 1, 2026 · Commercial, Medicaid | 55 | Original policy ↗ |
| Genetic Testing – Oncology Testing: Solid Tumor Molecular Diagnostics | Effective Jul 1, 2026 · Commercial, Medicaid | 108 | Original policy ↗ |
| Genetic Testing – Reproductive Testing: Carrier Screening | Effective Jul 1, 2026 · Commercial, Medicaid | 30 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Cardiovascular | Effective Jul 1, 2026 · Commercial, Medicaid | 29 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Dermatology | Effective Jul 1, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Neurology | Effective Jul 1, 2026 · Commercial, Medicaid | 48 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Ophthalmology (GBP) | Effective Jul 1, 2026 · Commercial, Medicaid | 13 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Orthopedics | Effective Jul 1, 2026 · Commercial, Medicaid | 18 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Otolaryngology | Effective Jul 1, 2026 · Commercial, Medicaid | 5 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Respiratory | Effective Jul 1, 2026 · Commercial, Medicaid | 14 | Original policy ↗ |
| Genetic Testing – Specialty Testing: Transplant | Effective Jul 1, 2026 · Commercial, Medicaid | 19 | Original policy ↗ |
| Genetic Testing- Specialty Testing: Nephrology | Effective Jul 1, 2026 · Commercial, Medicaid | 12 | Original policy ↗ |
| Genetic Testing: General Approach to Laboratory Testing | Effective Jul 1, 2026 · Commercial, Medicaid | — | Original policy ↗ |
