| FcRn Blockers – Commercial Medical Benefit Drug Policy | 2026D0111P · Effective Oct 1, 2026 · Commercial | 4 | Original policy ↗ |
| FDA Cleared or Approved Companion Diagnostic Testing | 2026T0653H · Effective Jul 1, 2026 · Commercial | 10 | Original policy ↗ |
| Fecal Calprotectin Testing Policy, Professional and Facility | 2026R8005A · Effective Dec 1, 2025 · Commercial | 1 | Original policy ↗ |
| Flow Cytometry Policy, Professional and Facility | 2026R8013A · Commercial | 13 | Original policy ↗ |
| From – To Date Policy, Professional | Commercial | 2 | Original policy ↗ |
| Gamifant® (Emapalumab-Lzsg) | 2026D0077L · Effective Oct 1, 2026 · Commercial | 1 | Original policy ↗ |
| Gastroesophageal and Gastrointestinal (GI) Services and Procedures | MMP039.20 · Effective Oct 1, 2026 | 10 | Original policy ↗ |
| Gastrointestinal Disorders Diagnostic Procedures | 2026T0415II · Effective Jun 1, 2026 · Commercial | 9 | Original policy ↗ |
| Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing for Infectious Diarrhea | 2026T0604M · Effective Jan 1, 2026 · Commercial | 3 | Original policy ↗ |
| Gazyva® (Obinutuzumab) | 2026D0140A · Effective Jan 1, 2026 · Commercial | 1 | Original policy ↗ |
| Gender Dysphoria and Gender Reassignment Surgery | MMP365.15 · Effective Oct 1, 2026 | 146 | Original policy ↗ |
| Gender Dysphoria Treatment | 2026T0580V · Effective Oct 1, 2026 · Commercial | 135 | Original policy ↗ |
| Genetic Testing for Cardiac Disease | 2026T0552DD · Effective Sep 1, 2026 · Commercial | 14 | Original policy ↗ |
| Genetic Testing for Hereditary Cancer | 2026T0009VV · Effective Oct 1, 2026 · Commercial | 36 | Original policy ↗ |
| Genetic Testing for Neurological Disorders | 2026T0598O · Effective Sep 1, 2026 · Commercial | 4 | Original policy ↗ |
| Givlaari® (Givosiran) | 2026D0087I · Effective Apr 1, 2026 · Commercial | 1 | Original policy ↗ |
| Glaucoma Surgical Treatments | 2026T0443MM · Effective Sep 1, 2026 · Commercial | 23 | Original policy ↗ |
| Global Days Policy, Professional | Commercial | 7 | Original policy ↗ |
| Gonadotropin Releasing Hormone Analogs | 2025D0038W · Effective Jul 1, 2025 · Commercial | 10 | Original policy ↗ |
| Gynecomastia Surgery | MP.012.22 · Effective Jun 1, 2026 · Commercial | — | Original policy ↗ |
| Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) | MP.026.27 · Effective Jul 1, 2026 · Commercial | 55 | Original policy ↗ |
| Hearing Aids and Auditory Implants | MMP394.15 · Effective Aug 1, 2026 | 4 | Original policy ↗ |
| Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable | 2026T0396II · Effective Mar 1, 2026 · Commercial | 66 | Original policy ↗ |
| Hemgenix® (Etranacogene Dezaparvovec-Drlb) – Commercial and Individual Exchange Medical Benefit Drug Policy | 2026D0120K · Effective Jun 1, 2026 · Commercial | 1 | Original policy ↗ |
| Hepatic Fibrosis Testing for Chronic Liver Disease Policy, Professional and Facility | 2026R8022A · Effective Sep 1, 2026 · Commercial | 7 | Original policy ↗ |
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | 2025D0044P · Effective Nov 1, 2025 · Commercial | 4 | Original policy ↗ |
| Home Health Services Policy, Professional | Commercial | 35 | Original policy ↗ |
| Home Health, Skilled, and Custodial Care Services | MP.022.28 · Effective Jul 1, 2026 · Commercial | 136 | Original policy ↗ |
| Home Traction Therapy – Commercial and Individual Exchange Medical Policy | 2026T0545Y · Commercial | 8 | Original policy ↗ |
| Homocysteine Testing for Metabolism Policy, Professional and Facility | 2026R8016A · Effective Aug 26, 2026 · Commercial | 1 | Original policy ↗ |
| Hospital Based Ambulance Policy, Facility | Commercial | 12 | Original policy ↗ |
| Hospital Inclusive Charges Policy, Facility | Commercial | — | Original policy ↗ |
| Hospital Services: Observation and Inpatient | 2026T0643J · Effective Aug 1, 2026 · Commercial | — | Original policy ↗ |
| Hospital, Emergency, and Ambulance Services | MMP046.12 · Effective Sep 1, 2026 | — | Original policy ↗ |
| Hyperbaric Oxygen Therapy and Topical Oxygen Therapy | 2026T0632J · Effective May 1, 2026 · Commercial | 4 | Original policy ↗ |
| Hysterectomy | 2026T0572Y · Effective Jan 1, 2026 · Commercial | 24 | Original policy ↗ |
| Ilaris® (Canakinumab) | 2025D0066L · Effective Nov 1, 2025 · Commercial | 1 | Original policy ↗ |
| Ilumya® (Tildrakizumab-Asmn) | 2026D0074O · Effective Jun 1, 2026 · Commercial | 1 | Original policy ↗ |
| Immune Cell Function Assay Policy, Professional and Facility | 2026R8006A · Effective Dec 1, 2025 · Commercial | 3 | Original policy ↗ |
| Immune Globulin (IVIG and SCIG) – Commercial Medical Benefit Drug Policy | 2026D0035AV · Effective Oct 1, 2026 · Commercial | 21 | Original policy ↗ |
| Implantable Loop Recorders and Wearable Heart Rhythm Monitors | 2026T0489JJ · Effective May 1, 2026 · Commercial | 11 | Original policy ↗ |
| Implanted Electrical Stimulator for the Spinal Cord | 2026T0567DD · Effective Jan 1, 2026 · Commercial | 12 | Original policy ↗ |
| Implanted Spinal Drug Delivery Systems | 2026T0626O · Effective Sep 10, 2026 · Commercial | 13 | Original policy ↗ |
| In Vitro Chemotherapy Assays Policy, Professional and Facility | 2026R8019A · Effective Sep 1, 2026 · Commercial | 8 | Original policy ↗ |
| Increased Procedural Services Policy, Professional | Commercial | 30 | Original policy ↗ |
| Infertility Diagnosis, Treatment, and Fertility Preservation | 2026T0270NN · Effective Jun 1, 2026 · Commercial | 135 | Original policy ↗ |
| Infliximab (Avsola®, Inflectra®, Remicade®, & Renflexis®) | 2026D0004AR · Effective Feb 1, 2026 · Commercial | 4 | Original policy ↗ |
| Inhaled Nitric Oxide Therapy | 2026T0607N · Effective Sep 1, 2026 · Commercial | 1 | Original policy ↗ |
| Injectable Dermal Fillers and Bulking Agents | 2026T0650G · Effective Oct 1, 2026 · Commercial | 7 | Original policy ↗ |
| Injection and Infusion Services Policy, Professional | Commercial | 7 | Original policy ↗ |
