| Sepsis | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Skin and Soft Tissue Substitutes | 357 · Commercial, Medicaid | 392 | Original policy ↗ |
| Skin and Soft Tissue Substitutes MEDICARE | | 392 | Original policy ↗ |
| Skysona (elivaldogene autotemcel) | Commercial, Medicaid | 3 | Original policy ↗ |
| Sleep Apnea or Snoring (eXciteObstructive Sleep Apnea (OSA)): MEDICARE | 422b | 2 | Original policy ↗ |
| Small Bowel Multivisceral Transplantation | Commercial, Medicaid | 24 | Original policy ↗ |
| Smart Watch Photoplethysmography (PPG) for Detection of Atrial Fibrillation | 341 · Commercial | 6 | Original policy ↗ |
| South Carolina Molina Clinical Policy - Sterilization | MCP 600 · Effective Sep 9, 2024 · Medicaid · SC | 1 | Original policy ↗ |
| Specimen Validity Testing | Effective Aug 29, 2025 · Commercial | 12 | Original policy ↗ |
| Specimen Validity Testing | Effective Sep 8, 2023 · Medicaid | 8 | Original policy ↗ |
| Speech Generating Devices | Commercial, Medicaid | 13 | Original policy ↗ |
| Speech Therapy for Feeding Disorders | Commercial, Medicaid | 10 | Original policy ↗ |
| Spinraza (nusinersen) | 293 · Commercial, Medicaid | 2 | Original policy ↗ |
| Split-Night-Sleep-Study | Commercial, Medicaid | 5 | Original policy ↗ |
| Split-Night-Sleep-Study | | 7 | Original policy ↗ |
| Split-Night-Sleep-Study | Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 5 | Original policy ↗ |
| Status Indicator Flag B Bundled Codes | Commercial, Medicaid | — | Original policy ↗ |
| Status Indicator Flag B Bundled Codes | Medicaid · AZ, IA, ID, MI, NE, OH, SC, TX, UT, WI | — | Original policy ↗ |
| Steerable Ureteroscopic Renal Evacuation | 477 · Commercial, Medicaid | 1 | Original policy ↗ |
| Steerable Ureteroscopic Renal Evacuation (SURE): MEDICARE | 477b · Effective Dec 17, 2025 | 1 | Original policy ↗ |
| Stem Cell Therapy for Orthopedic Applications | 426 · Effective Oct 8, 2025 · Commercial, Medicaid | 26 | Original policy ↗ |
| Steroid-Eluting Sinus Stents and Implants (PROPEL, SINUVA) | 333 · Commercial | 4 | Original policy ↗ |
| STI Lab Panel Testing | Commercial, Medicaid | 8 | Original policy ↗ |
| STI Lab Panel Testing | Medicaid · AZ, FL, IA, NE, OH, SC, TX, WI | 8 | Original policy ↗ |
| Tecartus (brexucabtagene autoleucel) | 378 · Commercial, Medicaid | 5 | Original policy ↗ |
| Tecelra (afamitresgene autoleucel) | Commercial, Medicaid | 3 | Original policy ↗ |
| Tendon Injections Missing Diagnosis | Effective Aug 20, 2025 · Commercial, Medicaid | 4 | Original policy ↗ |
| Tendon Injections Missing Diagnosis | Effective Aug 20, 2025 · Medicaid · AZ, CA, FL, IA, ID, NE, NM, OH, SC, TX, UT, WI | 4 | Original policy ↗ |
| Therapy Modifier Coding | Commercial, Medicaid | — | Original policy ↗ |
| Therapy Modifier Coding | | — | Original policy ↗ |
| Thermography and BSGI Imaging for the Detection of Breast Lesions | 127 · Commercial | 5 | Original policy ↗ |
| Topical and Intralesional Therapies | Commercial, Medicaid | 12 | Original policy ↗ |
| Topical Oxygen Therapy | Commercial | 1 | Original policy ↗ |
| Transcatheter Mitral Valve Implantation | 437 · Commercial, Medicaid | 2 | Original policy ↗ |
| Tregzi (allogeneic regulatory T cell immunotherapy with HSPC and T cells-vldq) | Commercial, Medicaid | 5 | Original policy ↗ |
| Tudriqev (vusolimogene oderparepec) | 486 · Effective Aug 12, 2026 · Commercial, Medicaid | 4 | Original policy ↗ |
| Tudriqev (vusolimogene oderparepec): MEDICARE | 486b · Effective Aug 19, 2026 | 4 | Original policy ↗ |
| Unlisted Coding | Commercial, Medicaid | 25 | Original policy ↗ |
| Unlisted Coding | Medicaid · AZ, IA, ID, MI, NE, OH, SC, TX, UT, WI | 25 | Original policy ↗ |
| Unspecified Codes in an Inpatient Setting | Commercial | — | Original policy ↗ |
| Unspecified Codes in an Inpatient Setting | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Visudyne (verteporfin) for Ocular Photodynamic Therapy | 308 · Commercial, Medicaid | 4 | Original policy ↗ |
| Vyjuvek (beremagene geperpavec) | Commercial, Medicaid | 1 | Original policy ↗ |
| Waskyra (etuvetidigene autotemcel) | Commercial, Medicaid | 5 | Original policy ↗ |
| Waskyra (etuvetidigene autotemcel) MEDICARE | | 5 | Original policy ↗ |
| Water Vapor Thermal Therapy for BPH | 384 · Commercial, Medicaid | 1 | Original policy ↗ |
| Wearable Cardioverter-Defibrillator Devices | 451 · Commercial, Medicaid | 6 | Original policy ↗ |
| Wheelchair-Mounted Robotic Arm Devices | 446 · Effective Dec 10, 2025 · Commercial, Medicaid | 2 | Original policy ↗ |
| Whole Body MRI | Commercial, Medicaid | 2 | Original policy ↗ |
| Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders | 382 · Effective Jun 10, 2026 · Commercial, Medicaid | 1 | Original policy ↗ |