| 10/1/2026 | 10/01/2026 updates to the Commercial Experimental/Investigational Services policy | This document is intended to communicate upcoming updates to the
Experimental/Investigational Services policy, effective 10/1/2026. These
updates reflect routine maintenance of the policy, including the termination, revision, addition
and/or removal of codes and services. These updates can be driven by the release of new codes, changes in
coverage determinations, the archival of other medical policies, as well as the
development or revision of other medical policies where certain codes have been
identified to be more clinically applicable.
| 0.1 | | 10/01/2026 updates to the Commercial Experimental/Investigational Services policy | 6e00208c-10bc-4c6a-bd89-f013a133e45e |
| 10/1/2026 | 10/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | The intent of this document is to communicate the Company's Commercial coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 10/01/2026, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable.
| 01 | | 10/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 62287406-b671-4564-af40-0d2cf63550ea |
| 9/21/2026 | New Preventive Coverage of mRNA influenza Vaccine (MFLUSIVA) for Commercial Members effective August 5, 2026. | Effective August 5, 2026,the purpose of this article is to communicate new preventive coverage of the mRNA influenza vaccine (MFLUSIVA) for commercial members in the prevention of influenza disease caused by influenza virus subtypes A and type B in individuals 50 years of age and older.
| 0.1 | | New Preventive Coverage of mRNA influenza Vaccine (MFLUSIVA) for Commercial Members effective August 5, 2026. | cc34b3ad-ffd1-4430-9642-15ca1eb4e053 |
| 8/13/2026 | Preventive Coverage Update of Combined Chlamydia and Gonorrhea Testing for Commercial Members for the work-up and follow-up for pre-exposure prophylaxis for the prevention of HIV (Effective 07/01/2026) | The purpose of this communication is to provide notice of updated preventive coverage for chlamydia and gonorrhea testing for Commercial Members for the work-up and follow-up of pre-exposure prophylaxis for the prevention of HIV.
| 0.1 | | Preventive Coverage Update of Combined Chlamydia and Gonorrhea Testing for Commercial Members for the work-up and follow-up for pre-exposure prophylaxis for the prevention of HIV (Effective 07/01/2026) | 90470d84-8688-4885-af72-000bede915cd |
| 8/13/2026 | Expanded coverage for Capvaxive, a pneumococcal 21-valent conjugate vaccine for Commercial Members (Effective 06/17/2026) | Effective June 17, 2026, the purpose of this document is to communicate expanded non-routine vaccine coverage for Capvaxive, a pneumococcal 21-valent conjugate vaccine for commercial members to include children and adolescents 2 through 17 years of age with increased risk of pneumococcal disease.
| 0.1 | | Expanded coverage for Capvaxive, a pneumococcal 21-valent conjugate vaccine for Commercial Members (Effective 06/17/2026) | 7b36151a-cbad-4178-aa30-510efbdb38a7 |
| 8/3/2026 | High-Intensity Focused Ultrasound (HIFU) in the Treatment of Malignant Prostate Tissue for Commercial Members (Effective July 1, 2026) | This communication is being issued to provide notification of the updated coverage position for high-intensity focused ultrasound in the treatment of malignant prostate tissue for Commercial members. - Effective July 01, 2026, the coverage position for high-intensity focused ultrasound has been updated.
| 0.1 | | High-Intensity Focused Ultrasound (HIFU) in the Treatment of Malignant Prostate Tissue for Commercial Members (Effective July 1, 2026) | 6d2f8d84-bdfe-41f2-a90c-dd272b103f2f |
| 7/1/2026 | 07/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | The intent of this document is to communicate the Company's Commercial coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 07/01/2026, unless otherwise noted.
For more information related to these services, please refer to specific policies when applicable. | 0.1 | | 07/01/2026 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products | 3a72dee6-9853-4b04-9c74-b7097b6e7b0e |
| 4/13/2026 | Expanded coverage for Arexvy, an adjuvanted respiratory syncytial virus (RSV) vaccine for Commercial Members (Retroactively effective 03/11/2026) | The purpose of this document is to communicate expanded non-routine vaccine coverage for Arexvy (retroactively effective to March 11, 2026), an adjuvanted respiratory syncytial virus (RSV) vaccine for adult Commercial members aged 18 through 59 years who are at an increased risk for lower respiratory tract disease (LRTD) caused by RSV.
| 0.1 | | Expanded coverage for Arexvy, an adjuvanted respiratory syncytial virus (RSV) vaccine for Commercial Members (Retroactively effective 03/11/2026) | 1b3ed5b0-ffd6-449e-a5d0-e600b8dfd0c3 |
| 2/2/2026 | Coverage of Meningococcal Groups A, B, C, W, and Y Vaccine (PENMENVY) for Commercial Members (Retroactively Effective 02/14/2025) | Retroactively effective to February 14, 2025, the purpose of this document is to communicate updated coverage and preventive coverage criteria for meningococcal Groups A, B, C, W, and Y vaccine (PENMENVY) for Commercial members.
| 0.1 | | Coverage of Meningococcal Groups A, B, C, W, and Y Vaccine (PENMENVY) for Commercial Members (Retroactively Effective 02/14/2025) | 7a97288b-51b1-419d-a50f-c6ac3970d27d |
| 1/16/2026 | Coverage of Immune Globulin Intravenous (IVIG) and Subcutaneous (SCIG) for Measles Post-Exposure Prophylaxis in Commercial Members | The purpose of this document is to communicate the Company's coverage position for immune globulin intravenous (IVIG) and subcutaneous (SCIG) for measles post-exposure prophylaxis in Commercial members who are severely immunocompromised or pregnant without evidence of immunity.
| 0.1 | | Coverage of Immune Globulin Intravenous (IVIG) and Subcutaneous (SCIG) for Measles Post-Exposure Prophylaxis in Commercial Members | 3ef527ca-2e9c-422a-bf9c-58819f3a9411 |
| 9/23/2025 | Preventive Coverage of Clesrovimab (Enflonsia) for Commercial Members (Retroactively Effective 08/04/2025) | Retroactively effective to August 4, 2025, the purpose of this
communication is to provide notice regarding the updated coverage and
preventive coverage for clesrovimab (Enflonsia), a respiratory syncytial
virus (RSV) immunization for Commercial members.
| 0.1 | | Preventive Coverage of Clesrovimab (Enflonsia) for Commercial Members (Retroactively Effective 08/04/2025) | 76e19c86-a4e7-4197-a7a0-c92a141bcfe3 |
| 8/26/2025 | Preventive Coverage Expansion of Respiratory Syncytial Virus Vaccine for Commercial Members (Retroactively Effective June 12, 2025) | The purpose of this communication is to provide notice of updates to coverage of respiratory syncytial virus vaccine (RSV) for the following: - Retroactively effective to June 12, 2025, the medically necessary coverage for non-routine use of respiratory syncytial virus vaccine (
 mRESVIA) was updated to include individuals 18 to 59 years of age who are at increased risk of severe RSV disease.
- Retroactively effective to June 25, 2025, the medically necessary coverage and preventive coverage criteria were updated to expand for the respiratory syncytial virus vaccine to cover adults 50 to 59 years of age who are at increased risk of severe RSV disease.
| 0.1 | | Preventive Coverage Expansion of Respiratory Syncytial Virus Vaccine for Commercial Members (Retroactively Effective June 12, 2025) | 64ddfb69-4c28-4b15-b313-2583e6294a2a |
| 4/22/2025 | Clarification on the coverage of Meningococcal (Groups A, C, W, and Y) conjugate vaccines for Commercial Members (Retroactively Effective to November 18, 2024) | The purpose of this communication is to clarify the Company's coverage position for our Commercial members regarding meningococcal (Groups A, C, W, and Y) conjugate vaccines, which is retroactively effective to November 18, 2024.
| 0.1 | | Clarification on the coverage of Meningococcal (Groups A, C, W, and Y) conjugate vaccines for Commercial Members (Retroactively Effective to November 18, 2024) | 36814671-c09d-47ea-b32d-ae74ee8b9491 |
| 12/23/2024 | Coverage Expansion of Respiratory Syncytial Virus Vaccine (Abrysvo) for Commercial Members (Retroactively Effective October 22, 2024) | The
purpose of this communication is to provide notice regarding the updated
coverage criteria for respiratory syncytial virus vaccine (Abrysvo)
retroactively effective to October 22, 2024 for Commercial members.
| 0.1 | | Coverage Expansion of Respiratory Syncytial Virus Vaccine (Abrysvo) for Commercial Members (Retroactively Effective October 22, 2024) | f05014dc-7a85-4ece-817d-bc8af057c54d |
| 5/12/2023 | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Commercial Members (Updated May 12, 2023) | The purpose of this communication is to provide notice regarding information and procedure codes related to testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence commercial members. Additionally, this Company document identifies when coverage is provided for clinical purposes, and the noncovered instances such as public health surveillance and screening.
| 0.1 | | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Commercial Members (Updated May 12, 2023) | 89689bbb-5b37-4282-b90a-69b3d315792d |
