| Ryplazim® (Plasminogen, Human-Tvmh) | 2026D0070H · Effective Mar 1, 2026 · Commercial | — | Original policy ↗ |
| Sacral Nerve Stimulation for Urinary and Fecal Indications | 2026T0630J · Effective Jan 1, 2026 · Commercial | 17 | Original policy ↗ |
| Sacroiliac Joint Interventions | 2026T0621O · Effective Sep 10, 2026 · Commercial | 4 | Original policy ↗ |
| Same Day / Same Service Policy, Professional | Commercial | 19 | Original policy ↗ |
| Saphnelo® (Anifrolumab-Fnia) | 2026D0109I · Effective Jul 1, 2026 · Commercial | 1 | Original policy ↗ |
| Scenesse® (Afamelanotide) | 2026D0092H · Effective Jul 1, 2026 · Commercial | 1 | Original policy ↗ |
| Self-Administered Medications | 2025D0073J · Effective Nov 1, 2025 · Commercial | — | Original policy ↗ |
| Sensory Integration Therapy and Auditory Integration Training | 2026T0314CC · Effective Jan 1, 2026 · Commercial | 1 | Original policy ↗ |
| Services and Modifiers Not Reimbursable to Health Care Professionals, Professional | Commercial | — | Original policy ↗ |
| Services by Residents, Interns and Medical Students Policy, Professional | Commercial | — | Original policy ↗ |
| Services Incident-to a Supervising Health Care Provider and Split or Shared Visits Policy, Professional | 2026R5025A · Commercial | 2 | Original policy ↗ |
| Simponi Aria® (Golimumab) Injection for Intravenous Infusion | 2026D0051S · Effective Mar 1, 2026 · Commercial | 1 | Original policy ↗ |
| Sinus Surgeries and Interventions | 2026T0571U · Effective Jul 1, 2026 · Commercial | 16 | Original policy ↗ |
| Skilled Nursing Facility, Rehabilitation, Long-Term Acute Care Hospital, and Private Duty Nursing | MMP079.19 · Effective Sep 1, 2026 | 39 | Original policy ↗ |
| Skin and Soft Tissue Substitutes | 2026T0592HH · Effective Aug 1, 2026 · Commercial | 346 | Original policy ↗ |
| Skin Substitutes Grafts/Cellular and Tissue-Based Products (Injections and/or Applications) | MMP105.22 · Effective Aug 1, 2026 | 347 | Original policy ↗ |
| Skyrizi® (Risankizumab-Rzaa) | 2026D0116H · Effective Aug 1, 2026 · Commercial | 1 | Original policy ↗ |
| Sleep Apnea Surgical Treatments | MMP087.15 · Effective Sep 1, 2026 | 9 | Original policy ↗ |
| Sleep Studies | 2026T0334SS · Effective Jul 1, 2026 · Commercial | 14 | Original policy ↗ |
| Sodium Hyaluronate | 2026D0081M · Effective Oct 1, 2026 · Commercial | 18 | Original policy ↗ |
| Somatostatin Analogs – Commercial and Individual Exchange Medical Benefit Drug Policy | 2026D0036W · Commercial | 5 | Original policy ↗ |
| Spevigo® (Spesolimab-Sbzo) | 2026D0119G · Effective Jun 1, 2026 · Commercial | 1 | Original policy ↗ |
| Spevigo® (Spesolimab-Sbzo) – IV and Subcutaneous Formulations (for UHCWest Only) | MMG209.C · Effective Jun 1, 2026 · Commercial | 1 | Original policy ↗ |
| Spinal Cord Stimulators for Chronic Pain | MMP368.14 · Effective Sep 1, 2026 | 3 | Original policy ↗ |
| Spinal Fusion and Bone Healing Enhancement Products – Commercial and Individual Exchange Medical Policy | 2026T0410KK · Commercial | 5 | Original policy ↗ |
| Spinal Fusion and Decompression | 2026T0639J · Effective Sep 1, 2026 · Commercial | 126 | Original policy ↗ |
| Spine Procedures | MMP089.18 · Effective Aug 1, 2026 | 79 | Original policy ↗ |
| Spinraza® (Nusinersen) | 2026D0059Q · Effective Sep 1, 2026 · Commercial | 1 | Original policy ↗ |
| Split Surgical Package Policy, Professional | Commercial | — | Original policy ↗ |
| Standby Services Policy, Professional | 2026R3003A · Effective Jul 1, 2026 · Commercial | 5 | Original policy ↗ |
| Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery | 2026T0611L · Effective Oct 1, 2026 · Commercial | 17 | Original policy ↗ |
| Subcutaneous Implantable Naltrexone Pellets | 2026D0078H · Effective Jan 1, 2026 · Commercial | 6 | Original policy ↗ |
| Supply Policy, Professional | Commercial | 19 | Original policy ↗ |
| Surgery for the Prevention and Treatment of Lymphedema | 2026T0636H · Effective Jan 1, 2026 · Commercial | 17 | Original policy ↗ |
| Surgery of the Ankle | 2026T0622O · Effective Jul 1, 2026 · Commercial | 10 | Original policy ↗ |
| Surgery of the Elbow | 2026T0551BB · Effective Aug 1, 2026 · Commercial | 10 | Original policy ↗ |
| Surgery of the Foot | 2026T0624P · Effective Oct 1, 2026 · Commercial | 10 | Original policy ↗ |
| Surgery of the Hip | 2026T0503KK · Effective Sep 10, 2026 · Commercial | 16 | Original policy ↗ |
| Surgery of the Knee | 2026T0553JJ · Effective Sep 10, 2026 · Commercial | 43 | Original policy ↗ |
| Surgery of the Shoulder | 2026T0556GG · Effective Sep 1, 2026 · Commercial | 17 | Original policy ↗ |
| Surgery of the Wrist or Thumb | 2026T0623M · Effective Aug 1, 2026 · Commercial | 10 | Original policy ↗ |
| Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins | 2026T0447SS · Effective Jul 1, 2026 · Commercial | 20 | Original policy ↗ |
| Surgical Procedures | MMP108.10 · Effective Sep 1, 2026 | 49 | Original policy ↗ |
| Susvimo® (Ranibizumab Injection) | 2026D0138C · Effective Aug 1, 2026 · Commercial | 1 | Original policy ↗ |
| Sympathetic Blockade | 2026T0627L · Effective Sep 10, 2026 · Commercial | 4 | Original policy ↗ |
| T Status Codes Policy, Professional | Commercial | 8 | Original policy ↗ |
| Testosterone Policy, Professional and Facility | 2026R8020A · Commercial | 6 | Original policy ↗ |
| Testosterone Replacement or Supplementation Therapy | 2026D0076J · Effective Jan 1, 2026 · Commercial | 6 | Original policy ↗ |
| Tezspire® (Tezepelumab-Ekko) | 2026D0110K · Effective Feb 1, 2026 · Commercial | 1 | Original policy ↗ |
| Tier 2 Molecular Pathology Procedures | MMP381.26 · Effective Sep 1, 2026 | 11 | Original policy ↗ |
