| Experimental and Investigational Services | Commercial, Medicaid | — | Original policy ↗ |
| Facility Bilateral or Anatomical Modifier Use | Commercial | — | Original policy ↗ |
| Facility Bilateral or Anatomical Modifier Use | Medicaid · AZ, CA, FL, IA, ID, IL, MA, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Facility Emergency Department Evaluation and Management leveling | Commercial, Medicaid | 3 | Original policy ↗ |
| Facility Emergency Department Evaluation and Management leveling | Medicaid · AZ, FL, IA, ID, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 3 | Original policy ↗ |
| Fee Schedule | Effective Aug 19, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Foot Surgery Bunionectomy | Commercial, Medicaid | 13 | Original policy ↗ |
| Foot Surgery Hallux Rigidus | Commercial, Medicaid | 7 | Original policy ↗ |
| Foot Surgery Lesser Toe Deformities Hammer Mallet and Claw Toe | Commercial | 7 | Original policy ↗ |
| Foot Surgery: Hallux Rigidus | MCP-701 · Medicaid · WA | 7 | Original policy ↗ |
| Fractional CO2 Laser Treatment for Traumatic and Burn Scars | Commercial | 2 | Original policy ↗ |
| Functional Electrical Stimulation for Spinal Cord Injury | Commercial, Medicaid | 2 | Original policy ↗ |
| Gastric Electrical Stimulation | 414 · Commercial | 14 | Original policy ↗ |
| Gastroesophageal Reflux Disease GERD Treatment | 337 · Commercial | 12 | Original policy ↗ |
| General Billing and Coding Policy | Commercial, Medicaid | — | Original policy ↗ |
| General Billing and Coding Policy | Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NV, NY, OH, SC, TX, WA, WI | — | Original policy ↗ |
| Genetic Testing | Commercial, Medicaid | 697 | Original policy ↗ |
| Genicular Artery Embolization of the Knee for Osteoarthritis | 410 · Commercial, Medicaid | 1 | Original policy ↗ |
| Genicular Radiofrequency Ablation RFA and Genicular Nerve Blocks for Chronic Knee Pain | Commercial | 5 | Original policy ↗ |
| Global Surgical Packages for Professional Providers | Effective Aug 8, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Heart Transplantation and Heart Transplantation with a Total Artificial Heart | Commercial | 11 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Hematologic Cancers | Commercial, Medicaid | 26 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Hematologic Disorders | Commercial, Medicaid | 23 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Non - Cancerous Diseases | 454 · Commercial | 24 | Original policy ↗ |
| Hematopoietic Stem Cell Transplantation for Solid Tumors | 457 · Commercial, Medicaid | 21 | Original policy ↗ |
| Hemgenix (etranacogene dezaparvovec-drlb) | 429 · Commercial, Medicaid | 3 | Original policy ↗ |
| High Dollar Pharmacy | Commercial | — | Original policy ↗ |
| High Dollar Pharmacy | Medicaid · FL, IA, ID, MA, MI, NM, NY, OH, SC, TX, WA, WI | — | Original policy ↗ |
| High Level Evaluation and Management with Preventive Medicine | Commercial | 10 | Original policy ↗ |
| High Level Evaluation and Management with Preventive Medicine | Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | 10 | Original policy ↗ |
| High-Level Evaluation and Management with Preventive Medicine | | 10 | Original policy ↗ |
| Hospice | Effective Feb 19, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Hospice Value Code 61 | Effective Aug 4, 2025 · Commercial, Medicaid | — | Original policy ↗ |
| Hospital Readmission Review | Commercial, Medicaid | — | Original policy ↗ |
| Hospital Routine Supplies Services | Commercial | — | Original policy ↗ |
| Hospital Routine Supplies Services | Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, OH, SC, TX, UT, WA, WI | — | Original policy ↗ |
| Hyaluronic Acid Injections | Medicaid | 13 | Original policy ↗ |
| Hydrolyzed Enteral Formula Diagnosis | Commercial | 30 | Original policy ↗ |
| Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (OSA) | 363 · Effective Apr 8, 2026 · Commercial, Medicaid | 9 | Original policy ↗ |
| ICD-10 First Listed Diagnosis Coding Policy | Commercial, Medicaid | — | Original policy ↗ |
| ICD-10 First Listed Diagnosis Coding Policy | | — | Original policy ↗ |
| ICD-10 Specificity | Commercial, Medicaid | 2 | Original policy ↗ |
| ICD-10 Specificity | | 1 | Original policy ↗ |
| Image Guided Radiation Therapy | Effective Aug 4, 2025 · Commercial, Medicaid | 5 | Original policy ↗ |
| Image Guided Radiation Therapy | Medicaid · UT, WA | 5 | Original policy ↗ |
| Image-Guided Bronchoscopy Evaluation of Pulmonary Lesions | Commercial, Medicaid | 4 | Original policy ↗ |
| Implantable Intrathecal Pain Pump | Commercial, Medicaid | 21 | Original policy ↗ |
| Implantable Neurostimulator for Central Sleep Apnea | 340 · Commercial, Medicaid | 13 | Original policy ↗ |
| Implantable Peripheral Nerve and Nerve Field Stimulators for Chronic Pain | 444 · Commercial, Medicaid | 28 | Original policy ↗ |
| Implantable Peripheral Nerve and Nerve Field Stimulators for Chronic Pain | MCP-444 · Medicaid · WA | 28 | Original policy ↗ |
