| Lupkynis (voclosporin) MHI | Medicaid · IL, MS | — | Original policy ↗ |
| Luxturna (voretigene neparvovec-rzyl) | 318 · Commercial, Medicaid | 2 | Original policy ↗ |
| Lyfgenia (lovotibeglogene autotemcel) | 448 · Commercial, Medicaid | 3 | Original policy ↗ |
| Lyfgenia (lovotibeglogene autotemcel), IL_Appendix (Medicaid): Policy No. 448 | 448 · Medicaid · IL | 3 | Original policy ↗ |
| Lyrica.Lyrica CR (pregabalin.pregabalin ER) MHI | Medicaid · IL, MS | — | Original policy ↗ |
| Magnetic Resonance Guided Focused Ultrasound (MRgFUS) for Essential Tremor | Commercial | 1 | Original policy ↗ |
| MCP-368: Transcatheter Tricuspid Valve Repair or Replacement | MCP-368 · Medicaid · IL | 5 | Original policy ↗ |
| MCP-433: Roctavian (valoctocogene roxaparvovec) | MCP-433 · Medicaid · IL | 3 | Original policy ↗ |
| Measurement of Carotid Artery Intima Thickness | Commercial, Medicaid | 1 | Original policy ↗ |
| Medical Necessity Review – IL Medicaid Only | C22913-A · Effective Apr 27, 2022 · Medicaid · IL | — | Original policy ↗ |
| Medical Supplies Home Health Consolidated Billing | Commercial, Medicaid | 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 ↗ |
| Medically Unlikely Edits | Medicaid · IL | 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 · IL | — | Original policy ↗ |
| Mepron (atovaquone) MHI | Medicaid · IL, MS | — | Original policy ↗ |
| Mepsevii (vestronidase alfa-vjbk) MHI | Medicaid · IL, MS | 1 | 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 ↗ |
| Mitapivat (Aqvesme, Pyrukynd) | C22822-A · Effective Mar 27, 2026 · Medicaid · IL, MS | — | Original policy ↗ |
| Mobile Cardiac Outpatient Telemetry | 428 · Commercial, Medicaid | 2 | Original policy ↗ |
| Modifier 25 | Commercial | — | Original policy ↗ |
| Modifier 26 | Commercial, Medicaid | — | Original policy ↗ |
| Modifier 26 | | — | Original policy ↗ |
| Modifier 26 | Medicaid · IL | — | Original policy ↗ |
| Modifier KK | Medicaid · IL | 7 | 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 TC | Medicaid · IL | 1 | 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 ↗ |
| Molina Healthcare Billing Requirements | Medicaid · IL | — | Original policy ↗ |
| Mozobil (plerixafor injection) MHI | Medicaid · IL, MS | 1 | Original policy ↗ |
| Mulpleta (lusutrombopag) MHI | Medicaid · IL, MS | — | Original policy ↗ |
| Multiple EM codes for the same provider same date of service | Commercial, Medicaid | 2 | Original policy ↗ |
| Multiple Procedure Payment Reduction Policy | Commercial, Medicaid | 24 | Original policy ↗ |
| Multiple Sclerosis Agents- Interferons MHI | Medicaid · IL, MS | 5 | Original policy ↗ |
| Myalept (metreleptin) MHI | Medicaid · IL, MS | — | 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 ↗ |
| Natroba IL Medicaid Only 30203-A | Medicaid · IL | — | Original policy ↗ |
