| Lab Panel | Commercial, Medicaid | 9 | Original policy ↗ |
| Lab Panel | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, WA, WI | 9 | Original policy ↗ |
| Labs Overlapping with Facility | Commercial, Medicaid | — | Original policy ↗ |
| Labs Overlapping with Facility | Medicaid · AZ, IA, ID, MI, NE, TX, WI | — | Original policy ↗ |
| Lenmeldy (atidarsagene autotemcel) | 453 · Commercial, Medicaid | 3 | Original policy ↗ |
| Liver Transplantation | 114 · Commercial | 15 | Original policy ↗ |
| Lumbar Artificial Intervertebral Disc Replacement | Commercial | 9 | Original policy ↗ |
| Lung Transplantation | Commercial | 13 | Original policy ↗ |
| Luxturna (voretigene neparvovec-rzyl) | 318 · Commercial, Medicaid | 2 | Original policy ↗ |
| Lyfgenia (lovotibeglogene autotemcel) | 448 · Commercial, Medicaid | 3 | Original policy ↗ |
| Magnetic Resonance Guided Focused Ultrasound (MRgFUS) for Essential Tremor | Commercial | 1 | Original policy ↗ |
| Measurement of Carotid Artery Intima Thickness | Commercial, Medicaid | 1 | Original policy ↗ |
| Medical Supplies Home Health Consolidated Billing | Commercial, Medicaid | 3 | Original policy ↗ |
| Medical Supplies Home Health Consolidated Billing | Effective Oct 23, 2023 · Medicaid · AZ, NE | 3 | Original policy ↗ |
| Medically Necessary | Commercial, Medicaid | — | Original policy ↗ |
| Medically Unlikely Edits | Commercial, Medicaid | 1 | Original policy ↗ |
| Medically Unlikely Edits | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 1 | Original policy ↗ |
| Member Not Active | Effective Dec 16, 2024 · Commercial, Medicaid | — | Original policy ↗ |
| Member PCP as Attending Provider in a ER Facility Setting | Commercial | — | Original policy ↗ |
| Member PCP as Attending Provider in a ER Facility Setting | | — | Original policy ↗ |
| Member PCP as Attending Provider in a ER Facility Setting | Medicaid · AZ, MI, NE | — | Original policy ↗ |
| Microwave Ablation Thermotherapy for Breast Cancer | Commercial | 1 | Original policy ↗ |
| Minimally Invasive Glaucoma Surgeries | Commercial | 5 | Original policy ↗ |
| Minimally Invasive Sacroiliac Joint Fusion | Commercial, Medicaid | 4 | Original policy ↗ |
| Mobile Cardiac Outpatient Telemetry | 428 · Commercial, Medicaid | 2 | Original policy ↗ |
| Modifier 25 | Commercial | — | Original policy ↗ |
| Modifier 25 | Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, OH, SC, TX, UT, WI | — | Original policy ↗ |
| Modifier 26 | Commercial, Medicaid | — | Original policy ↗ |
| Modifier 26 | | — | Original policy ↗ |
| Modifier 26 | Medicaid · AZ, CA, FL, IA, ID, MA, NE, NM, NY | — | Original policy ↗ |
| Modifier KX | Commercial, Medicaid | 7 | Original policy ↗ |
| Modifier KX | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 7 | Original policy ↗ |
| Modifier Technical Component Policy | Effective Aug 21, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Modifier Technical Component Policy | Effective Aug 21, 2025 · Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 2 | Original policy ↗ |
| Modifiers XE XS XP XU and 59 Usage | Commercial, Medicaid | — | Original policy ↗ |
| Modifiers XE XS XP XU and 59 Usage | | — | Original policy ↗ |
| Multiple EM codes for the same provider same date of service | Commercial, Medicaid | 2 | Original policy ↗ |
| Multiple EM codes for the same provider same date of service | Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, OH, SC, TX, UT, WI | 2 | Original policy ↗ |
| Multiple Procedure Payment Reduction Policy | Commercial, Medicaid | 24 | Original policy ↗ |
| Multiple Procedure Payment Reduction Policy | Medicaid · AZ, IA, ID, MI, NE, OH, TX, WI | 24 | Original policy ↗ |
| N C C I (NCCI) Procedure-to-Procedure with Modifiers | Effective Aug 5, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| N C C I (NCCI) Procedure-to-Procedure with Modifiers | Effective Aug 5, 2025 · Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| National Drug Code | Commercial | — | Original policy ↗ |
| National Drug Code | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NV, NY, OH, SC, TX, WA, WI | — | Original policy ↗ |
| Negative Pressure Wound Therapy | Commercial, Medicaid | 7 | Original policy ↗ |
| Neuromuscular Electrical Training for the Treatment of OSA or Snoring (eXciteOSA) | 422 · Commercial, Medicaid | 2 | Original policy ↗ |
| Neurostimulation Treatments for Epilepsy | Commercial, Medicaid | 54 | Original policy ↗ |
| Newborn and Neonatal Intensive Care Unit Policy | Effective Aug 6, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Newborn and Neonatal Intensive Care Unit Policy | Effective Aug 6, 2025 · Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Non-Emergent Air Ambulance Transport | Commercial, Medicaid | 10 | Original policy ↗ |
