| 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 ↗ |
| 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 26 | Commercial, Medicaid | — | Original policy ↗ |
| Modifier 26 | | — | 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 Procedure Payment Reduction Policy | Commercial, Medicaid | 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 ↗ |
| Negative Pressure Wound Therapy | MCP-407 · Effective Feb 11, 2026 · Medicaid · WA | 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 ↗ |
| Non-Invasive Abdominal/Visceral Vascular Studies | Commercial, Medicaid | — | Original policy ↗ |
| Non-Invasive Prenatal Testing | Effective Jul 31, 2025 · Commercial, Medicaid | 7 | Original policy ↗ |
| Non-Invasive Prenatal Testing | Effective Jul 31, 2025 · Medicaid · AZ, CA, FL, IA, ID, IL, MA, MI, NE, NM, NY, OH, SC, TX, WA, WI | 7 | Original policy ↗ |
| Noninvasive Positive Pressure Ventilation | 275 · Commercial, Medicaid | 3 | Original policy ↗ |
| NPFS Status Indicator T | Medicaid | — | Original policy ↗ |
| Observation | Commercial | 17 | Original policy ↗ |
| Observation | | 17 | Original policy ↗ |
| Observation | Medicaid · AZ, FL, IA, ID, IL, MI, NE, NY, OH, SC, TX, UT, WA, WI | 17 | Original policy ↗ |
| Occupational Therapy | 409 · Commercial, Medicaid | 28 | Original policy ↗ |
| Omisirge (omidubicel onlv) | Commercial, Medicaid | 5 | Original policy ↗ |
| Opioid Treatment Service | Medicaid | 18 | Original policy ↗ |
| Optum EDC Analyzer - Facility ER E&M Leveling Prepayment | Commercial, Medicaid | 6 | Original policy ↗ |
| Optum EDC Analyzer - Facility ER E&M Leveling Prepayment | Medicaid · AZ, CA, FL, IA, ID, MA, MI, NE, NM, NY, SC, TX, UT, WA, WI | 6 | Original policy ↗ |
| Optum Pause and Pay | Medicaid | — | Original policy ↗ |
| Otarmeni (lunsotogene parvec) | 485 · Commercial | 3 | Original policy ↗ |
| Otarmeni (lunsotogene parvec) MEDICARE | 485b | 3 | Original policy ↗ |
| Overlapping Room and Board | Commercial | — | Original policy ↗ |
| Packaged and conditionally packaged lab services | Commercial | — | Original policy ↗ |
