| Carvykti (ciltacabtagene autoleucel) | Commercial, Medicaid | 9 | Original policy ↗ |
| Casgevy (exagamglogene autotemcel) for Beta Thalassemia | 449 · Effective Aug 12, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Casgevy (exagamglogene autotemcel) for Sickle Cell Disease | 447 · Effective Aug 12, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Category III CPT Codes | Commercial, Medicaid | 214 | Original policy ↗ |
| Clinical Determinations of Appropriate Level of Care | MHI-Healthcare Services-394 · Effective May 2, 2016 · Commercial, Medicaid | — | Original policy ↗ |
| Clinical Diagnostic Laboratory Services | Commercial | 211 | Original policy ↗ |
| Clinical Diagnostic Laboratory Services | | 212 | Original policy ↗ |
| Clinical Diagnostic Laboratory Services | Medicaid · AZ, IA, MI, NE, OH, SC, TX, WI | 211 | Original policy ↗ |
| Clinical Trials and Rare Disease Policy | Commercial, Medicaid | 9 | Original policy ↗ |
| CMS Replacement Codes | Commercial, Medicaid | — | Original policy ↗ |
| CMS Replacement Codes | Medicaid · AZ, FL, IA, ID, NE, OH, SC, TX, UT, WI | — | Original policy ↗ |
| Co Surgeon Team Surgeon Professional | Commercial, Medicaid | 2 | Original policy ↗ |
| Co Surgeon Team Surgeon Professional | Medicaid · AZ, FL, IA, ID, IL, MI, NE, NM, NY, OH, SC, TX, UT, WI | 2 | Original policy ↗ |
| Colonoscopy and Sigmoidoscopy | Commercial | 35 | Original policy ↗ |
| Colonoscopy and Sigmoidoscopy | Medicaid · AZ, IA, ID, MI, NE, NV, OH, SC, TX, WI | 35 | Original policy ↗ |
| Condition Codes 49, 50, and 53 | Commercial, Medicaid | — | Original policy ↗ |
| Cooled Radiofrequency Ablation (CRFA) for the Management of Chronic Pain | 386 · Commercial, Medicaid | 7 | Original policy ↗ |
| Corneal Collagen Cross-Linking (CXL) | 328 · Effective Aug 12, 2026 · Commercial, Medicaid | 3 | Original policy ↗ |
| Corrected Claims | Commercial | — | Original policy ↗ |
| Cranial Orthotic Devices | Commercial | 3 | Original policy ↗ |
| Critical Care Codes when Discharging Home from the Emergency Department | Commercial | 2 | Original policy ↗ |
| Critical Care Codes when Discharging Home from the Emergency Department | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 2 | Original policy ↗ |
| Cross-Departmental Recovery Policy | Medicaid | — | Original policy ↗ |
| Cross-Departmental Recovery Policy | Medicaid · AZ, IA, ID, MI, NE, NV, OH, SC, TX, WI | — | Original policy ↗ |
| CT Computed Tomography of the Abdomen and Pelvis | Commercial | — | Original policy ↗ |
| CT Computed Tomography of the Abdomen and Pelvis | Medicaid · AZ, IA, ID, MI, NE, NV, OH, SC, TX, WI | — | Original policy ↗ |
| D M E Place of Service 31 or 32 | Effective Aug 6, 2025 · Medicaid | — | Original policy ↗ |
| D M E Place of Service 31 or 32 | Effective Aug 6, 2025 · Medicaid · AZ, IA, ID, MI, NE, OH, SC, TX, WI | — | Original policy ↗ |
| D R G (DRG) Clinical Validation | Effective Aug 1, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| D R G (DRG) Clinical Validation | Effective Aug 1, 2025 · Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Decision for Surgery Modifier 57 | Commercial, Medicaid | — | Original policy ↗ |
| Decision for Surgery Modifier 57 | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Developmental Testing | Commercial, Medicaid | 3 | Original policy ↗ |
| Diagnosis Code Coding | Commercial, Medicaid | — | Original policy ↗ |
| Diagnosis Code Coding | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Diagnosis Code Y65 XX | Commercial, Medicaid | — | Original policy ↗ |
| Diagnosis Code Y65 XX | Medicaid · AZ, IA, ID, MI, NE, OH, SC, TX, UT, WI | — | Original policy ↗ |
| Discontinued Procedures | Effective Aug 4, 2025 · Commercial, Medicaid | 4 | Original policy ↗ |
| Discontinued Procedures | Effective Aug 4, 2025 · Medicaid · AZ, FL, IA, ID, IL, MA, NE, NM, NY, OH, SC, TX, UT, WA, WI | 4 | Original policy ↗ |
| DME Non Invasive Ventilator Settings | Commercial, Medicaid | 6 | Original policy ↗ |
| DME Non Invasive Ventilator Settings | Medicaid · AZ, IA, ID, MI, NE, NV, OH, SC, TX, WI | 6 | Original policy ↗ |
| DME Place of Service Separately Reimbursable | Commercial, Medicaid | 9 | Original policy ↗ |
| DME Place of Service Separately Reimbursable | Medicaid · AZ, IA, ID, MI, NE, OH, SC, TX, WI | 9 | Original policy ↗ |
| DME Rental Vs Purchase | Commercial | 629 | Original policy ↗ |
| Donor Lymphocyte Infusion and Hematopoietic Stem Cell Boosts | Commercial, Medicaid | 3 | Original policy ↗ |
| Duplicate Claims | Effective Aug 19, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Duplicate Claims | Effective Aug 19, 2025 · Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NY, OH, SC, TX, WA, WI | — | Original policy ↗ |
| Durable Medical Equipment K F (KF)F Modifier | Commercial, Medicaid | 14 | Original policy ↗ |
| Durable Medical Equipment K F (KF)F Modifier | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, WI | 14 | Original policy ↗ |
| Dynamic Exoskeletal Orthoses for Lower Extremity Injuries | Commercial, Medicaid | 3 | Original policy ↗ |
