| Modifiers 80, 81, 82 and AS: Assistant at Surgery | G-06005 · Effective Dec 19, 2023 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 80, 81, 82 and AS: Assistant at Surgery | G-06005 · Effective Dec 18, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifiers 90 and 91: Laboratory Services | G-20001 · Effective Dec 1, 2026 · Medicaid · MD | — | Original policy ↗ |
| Modifiers 90 and 91: Laboratory Services | G-20001 · Effective Dec 1, 2026 · SC, TX, WV | — | Original policy ↗ |
| Modifiers 90 and 91: Laboratory Services | G-20001 · Effective Dec 1, 2026 · Medicaid · TX | — | Original policy ↗ |
| Modifiers LT and RT | G-07022 · Effective Apr 3, 2017 · Medicaid · TX | — | Original policy ↗ |
| Modifiers LT and RT: Left-Side and Right-Side Procedures | G-07022 · Effective Jul 21, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifiers LT and RT: Left-Side and Right-Side Procedures | G-07022 · Effective Jul 21, 2025 · Medicaid · GA, MD, WA | — | Original policy ↗ |
| Modifiers LT and RT: Left-Side and Right-Side Procedures | G-07022 · Effective Jul 21, 2025 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifiers LT and RT: Left-Side and Right-Side Procedures | G-07022 · Effective Jul 21, 2025 · Medicaid · TX | — | Original policy ↗ |
| Multiple and Bilateral Surgery: Professional and Facility Reimbursement | Effective Mar 1, 2020 | — | Original policy ↗ |
| Multiple and Bilateral Surgery: Professional and Facility Reimbursement | Effective Oct 3, 2016 · Medicaid · WV | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Jul 17, 2024 · Medicaid · DC | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Jul 17, 2024 · Medicaid · MD | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Jul 17, 2024 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Jul 17, 2024 · Medicaid · TX | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Jul 17, 2024 · Medicaid · TX | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Apr 29, 2022 · Medicaid · TX | — | Original policy ↗ |
| Multiple Delivery Services | G-06044 · Effective Jul 17, 2024 · Medicaid · WV | — | Original policy ↗ |
| Multiple Radiology Payment Reduction | G-12002 · Effective Apr 1, 2026 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Multiple Radiology Payment Reduction | G-12002 · Effective Aug 15, 2022 · Medicaid · TX | — | Original policy ↗ |
| Multiple Radiology Payment Reduction | G-12002 · Effective Dec 1, 2024 · Medicaid · WV | — | Original policy ↗ |
| November 2021 Clinical Utilization Management (UM) Guidelines | Medicaid · TX | — | Original policy ↗ |
| November 2022 Clinical Utilization Management Guidelines | Medicaid · TX | — | Original policy ↗ |
| November 2023 Clinical Utilization Management Criteria | Medicaid · MD | — | Original policy ↗ |
| November 2024 Clinical Utilization Management Guidelines | Medicaid · DC | — | Original policy ↗ |
| November 2024 Clinical Utilization Management Guidelines | Medicaid · MD | — | Original policy ↗ |
| November 2024 Clinical Utilization Management Guidelines | Medicaid · TX | — | Original policy ↗ |
| November 2024 Clinical Utilization Management Guidelines | Medicaid · WV | — | Original policy ↗ |
| November 2025 Clinical Utilization Management Guidelines | Medicaid · MD | — | Original policy ↗ |
| November 2025 Clinical Utilization Management Guidelines | Medicaid · TX | — | Original policy ↗ |
| November 2025 Clinical Utilization Management Guidelines | Medicaid · WV | — | Original policy ↗ |
| Nurse Practitioner and Physician Assistant Services | G-20002 · Effective Nov 1, 2024 · Medicaid · MD | — | Original policy ↗ |
| Nurse Practitioner and Physician Assistant Services | G-20002 · Effective Nov 1, 2024 · SC | — | Original policy ↗ |
| Nurse Practitioner and Physician Assistant Services | G-20002 · Effective Nov 1, 2024 · Medicaid · TX | — | Original policy ↗ |
| Nurse Practitioner and Physician Assistant Services | G-20002 · Effective Nov 1, 2024 · Medicaid · WV | — | Original policy ↗ |
| Nursing Facility Provider Manual | Medicaid · TX | — | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Nov 14, 2025 · Medicaid · DC | — | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Nov 14, 2025 · Medicaid · MD | — | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Nov 14, 2025 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Jul 23, 2021 · Medicaid · TX | — | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Jul 23, 2021 · Medicaid · TX | — | Original policy ↗ |
| Portable/Mobile/Handheld Radiology Services | G-06160 · Effective Nov 14, 2025 · Medicaid · WV | — | Original policy ↗ |
| Preadmission Services for Inpatient Stays | G-01017 · Effective Sep 11, 2025 · Medicaid · DC | — | Original policy ↗ |
| Preadmission Services for Inpatient Stays | G-01017 · Effective Sep 11, 2025 · Medicaid · MD | — | Original policy ↗ |
| Preadmission Services for Inpatient Stays | G-01017 · Effective Apr 6, 2018 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Preadmission Services for Inpatient Stays | G-01017 · Effective Dec 11, 2023 · Medicaid · TX | — | Original policy ↗ |
| Preadmission Services for Inpatient Stays | G-01017 · Effective Sep 11, 2025 · Medicaid · WV | — | Original policy ↗ |
| Preadmission Services Inpatient Stays - Medicaid | G-01017 · Effective Sep 11, 2025 · Medicaid · TX | — | Original policy ↗ |
| Preventive Medicine and Sick Visits on the Same Day | G-05016 · Effective May 22, 2024 · Medicaid · DC | — | Original policy ↗ |
