| Policy Name | Posted Date | Effective Date |
| Allergen Testing (Commercial, BlueCare, Medicare Advantage, DSNP) - G2031 | 3/10/26 | 5/10/26 |
| Allergen Testing (FEP) - G2031 | 3/10/26 | 5/10/26 |
| B-Hemolytic Streptococcus Testing (Commercial, Medicare Advantage, DSNP) – G2159 | 2/25/25 | 4/25/25 |
| B-Hemolytic Streptococcus Testing (FEP) – G2159 | 2/25/25 | 4/25/25 |
| B-Hemolytic Streptococcus Testing (BlueCare) - G2159 | 4/22/25 | 6/25/25 |
| Biochemical Markers of Alzheimer Disease and Dementia (Commercial, BlueCare, Medicare Advantage, DSNP) - G2048 | 2/25/25 | 4/25/25 |
| Biochemical Markers of Alzheimer Disease and Dementia (FEP) - G2048 | 2/25/25 | 4/25/25 |
| Biomarker Testing for Autoimmune Rheumatic Disease (BlueCare, Medicare Advantage, DSNP) – G2022 | 3/10/26 | 5/10/26 |
| Biomarker Testing for Autoimmune Rheumatic Disease (Commercial) – G2022 | 3/10/26 | 5/10/26 |
| Biomarker Testing for Autoimmune Rheumatic Disease (FEP) – G2022 | 3/10/26 | 5/10/26 |
| Biomarkers for Myocardial Infarction and Chronic Heart Failure (Commercial, BlueCare, Medicare Advantage, DSNP) – G2150 | 2/25/25 | 4/25/25 |
| Biomarkers for Myocardial Infarction and Chronic Heart Failure (FEP) – G2150 | 2/25/25 | 4/25/25 |
| Bone Turnover Markers Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2051 | 2/25/25 | 4/25/25 |
| Bone Turnover Markers Testing (FEP) – G2051 | 2/25/25 | 4/25/25 |
| Cardiovascular Disease Risk Assessment (Commercial, BlueCare, Medicare Advantage, DSNP) - G2050 | 2/25/25 | 4/25/25 |
| Cardiovascular Disease Risk Assessment (FEP) – G2050 | 2/25/25 | 4/25/25 |
| Celiac Disease Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2043 | 2/25/25 | 4/25/25 |
| Celiac Disease Testing (FEP) – G2043 | 2/25/25 | 4/25/25 |
| Cervical Cancer Screening (Commercial, BlueCare) – G2002 | 2/25/25 | 4/25/25 |
| Cervical Cancer Screening (FEP) – G2002 | 2/25/25 | 4/25/25 |
| Cervical Cancer Screening (Medicare Advantage, DSNP) – G2002 | 2/25/25 | 4/25/25 |
| Coronavirus Testing in the Outpatient Setting (Commercial, BlueCare, Medicare Advantage, DSNP) - G2174 | 1/15/26 | 3/15/26 |
| Coronavirus Testing in the Outpatient Setting (FEP) - G2174 | 1/15/26 | 3/15/26 |
| Diabetes Mellitus Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2006 | 1/15/26 | 3/15/26 |
| Diabetes Mellitus Testing (FEP) – G2006 | 1/15/26 | 3/15/26 |
| Diagnosis of Idiopathic Environmental Intolerance (Commercial, BlueCare, Medicare Advantage, DSNP)– G2056 | 1/15/26 | 3/15/26 |
| Diagnosis of Idiopathic Environmental Intolerance (FEP) – G2056 | 1/15/26 | 3/15/26 |
| Diagnosis of Vaginitis (Commercial, BlueCare, Medicare Advantage, DSNP) – M2057 | 3/10/26 | 5/10/26 |
| Diagnosis of Vaginitis (FEP) – M2057 | 3/10/26 | 5/10/26 |
| Diagnostic Testing of Common Sexually Transmitted Infections (Commercial, BlueCare, Medicare Advantage, DSNP) – G2157 | 2/25/25 | 4/25/25 |
| Diagnostic Testing of Common Sexually Transmitted Infections (FEP) – G2157 | 2/25/25 | 4/25/25 |
| Diagnostic Testing of Influenza (Commercial, BlueCare, Medicare Advantage, DSNP) – G2119 | 2/25/25 | 4/25/25 |
| Diagnostic Testing of Influenza (FEP) – G2119 | 2/25/25 | 4/25/25 |
| Diagnostic Testing of Iron Homeostasis and Metabolism (Commercial, BlueCare, Medicare Advantage, DSNP) – G2011 | 1/15/26 | 3/15/26 |
| Diagnostic Testing of Iron Homeostasis and Metabolism (FEP) – G2011 | 1/15/26 | 3/15/26 |
| Epithelial Cell Cytology in Breast Cancer Risk Assessment (Commercial, BlueCare, Medicare Advantage, DSNP) – G2059 | 2/25/25 | 4/25/25 |
| Epithelial Cell Cytology in Breast Cancer Risk Assessment (FEP) – G2059 | 2/25/25 | 4/25/25 |
| Evaluation of Dry Eyes (Commercial, BlueCare, Medicare Advantage, DSNP) – G2138 | 3/10/26 | 5/10/26 |
| Evaluation of Dry Eyes (FEP) – G2138 | 3/10/26 | 5/10/26 |
| Fecal Analysis in the Diagnosis of Intestinal and Fecal Microbiota Transplant Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2060 | 2/25/25 | 4/25/25 |
| Fecal Analysis in the Diagnosis of Intestinal and Fecal Microbiota Transplant Testing (FEP) – G2060 | 2/25/25 | 4/25/25 |
| Fecal Calprotectin Testing in Adults (Commercial, Medicare Advantage, BlueCare, DSNP; not adopted for FEP) – G2061 | 2/25/25 | 4/25/25 |
| Flow Cytometry (Commercial, BlueCare, Medicare Advantage, DSNP) – F2019 | 3/10/26 | 5/10/26 |
| Flow Cytometry (FEP) – F2019 | 3/10/26 | 5/10/26 |
| Folate Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2154 | 2/25/25 | 4/25/25 |
| Folate Testing (FEP) – G2154 | 2/25/25 | 4/25/25 |
| Gamma-glutamyl Transferase Testing in Adults (Commercial, BlueCare, Medicare Advantage, DSNP) – G2173 | 2/25/25 | 4/25/25 |
| Gamma-glutamyl Transferase Testing in Adults (FEP) – G2173 | 2/25/25 | 4/25/25 |
| General Inflammation Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2155 | 2/25/25 | 4/25/25 |
| General Inflammation Testing (FEP) – G2155 | 2/25/25 | 4/25/25 |
| Helicobacter Pylori Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2044 | 3/10/26 | 5/10/26 |
| Helicobacter Pylori Testing (FEP) – G2044 | 3/10/26 | 5/10/26 |
| Hepatitis Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2036 | 2/25/25 | 4/25/25 |
| Hepatitis Testing (FEP) – G2036 | 2/25/25 | 4/25/25 |
| Human Immunodeficiency Virus (HIV) (Commercial, BlueCare, Medicare Advantage, DSNP) – M2116 | 3/10/26 | 5/10/26 |
| Human Immunodeficiency Virus (HIV) (FEP) – M2116 | 3/10/26 | 5/10/26 |
| Identification of Microorganisms Using Nucleic Acid Probes (Commercial, BlueCare, Medicare Advantage, DSNP) – M2097 | 2/25/25 | 4/25/25 |
| Identification of Microorganisms Using Nucleic Acid Probes (FEP) – M2097 | 2/25/25 | 4/25/25 |
| Immune Cell Function Assay (Commercial, Medicare Advantage, DSNP; not adopted for FEP) – G2098 | 1/15/26 | 3/15/26 |
| Immunohistochemistry (Commercial, BlueCare, Medicare Advantage, DSNP) – P2018 | 1/15/26 | 3/15/26 |
| Immunohistochemistry (FEP) – P2018 | 1/15/26 | 3/15/26 |
| Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (Commercial, BlueCare, Medicare Advantage, DSNP) – G2105 | 2/25/25 | 4/25/25 |
| Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (FEP) – G2105 | 2/25/25 | 4/25/25 |
| In Vitro Chemoresistance and Chemosensitivity Assays (Commercial, BlueCare, Medicare Advantage, DSNP) – G2100 | 2/25/25 | 4/25/25 |
| In Vitro Chemoresistance and Chemosensitivity Assays (FEP) – G2100 | 2/25/25 | 4/25/25 |
| Intracellular Micronutrient Analysis (Commercial, BlueCare, Medicare Advantage, DSNP) – G2099 | 3/10/26 | 5/10/26 |
| Intracellular Micronutrient Analysis (FEP) – G2099 | 3/10/26 | 5/10/26 |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease (Commercial, BlueCare, Medicare Advantage, DSNP) – G2121 | 2/25/25 | 4/25/25 |
| Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease (FEP) G2121 | 2/25/25 | 4/25/25 |
| Lyme Disease Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2143 | 3/10/26 | 5/10/26 |
| Lyme Disease Testing (FEP) – G2143 | 3/10/26 | 5/10/26 |
| Metabolites Markers of Thiopurines Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2115 | 2/25/25 | 4/25/25 |
| Metabolites Markers of Thiopurines Testing (FEP) – G2115 | 2/25/25 | 4/25/25 |
| Nerve Fiber Density Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – M2112 | 2/25/25 | 4/25/25 |
| Nerve Fiber Density Testing (FEP) – M2112 | 2/25/25 | 4/25/25 |
| Onychomycosis Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – M2172 | 3/10/26 | 5/10/26 |
| Onychomycosis Testing (FEP) – M2172 | 3/10/26 | 5/10/26 |
| Oral Cancer Screening and Testing (Commercial, Bluecare, Medicare Advantage, DSNP) – G2113 | 2/25/25 | 4/25/25 |
| Oral Cancer Screening and Testing (FEP) – G2113 | 2/25/25 | 4/25/25 |
| Pancreatic Enzyme Testing for Acute Pancreatitis (Commercial, BlueCare, Medicare Advantage, DSNP) – G2153 | 2/25/25 | 4/25/25 |
| Pancreatic Enzyme Testing for Acute Pancreatitis (FEP) – G2153 | 2/25/25 | 4/25/25 |
| Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2164 | 3/10/26 | 5/10/26 |
| Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (FEP) – G2164 | 3/10/26 | 5/10/26 |
| Pathogen Panel Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2149 | 2/25/25 | 4/25/25 |
| Pathogen Panel Testing (FEP) – G2149 | 2/25/25 | 4/25/25 |
| Pediatric Preventive Screening (Commercial, BlueCare, Medicare Advantage, DSNP) – G2042 | 3/10/26 | 5/10/26 |
| Pediatric Preventive Screening (FEP) – G2042 | 3/10/26 | 5/10/26 |
| Prenatal Screening (Nongenetic) (Commercial, BlueCare, Medicare Advantage, DSNP) – G2035 | 3/10/26 | 5/10/26 |
| Prenatal Screening (Nongenetic) (FEP) – G2035 | 3/10/26 | 5/10/26 |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting (BlueCare) – T2015 | 3/10/26 | 5/10/26 |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting (Commercial) – T2015 | 3/10/26 | 5/10/26 |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting (FEP) – T2015 | 3/10/26 | 5/10/26 |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting (Medicare Advantage, DSNP) – T2015 | 3/10/26 | 5/10/26 |
| Prostate Biopsy Specimen Analysis (Commercial, BlueCare, Medicare Advantage, DSNP) – G2007 | 2/25/25 | 4/25/25 |
| Prostate Biopsy Specimen Analysis (FEP) – G2007 | 2/25/25 | 4/25/25 |
| Salivary Hormone Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2120 | 3/10/26 | 5/10/26 |
| Salivary Hormone Testing (FEP) – G2120 | 3/10/26 | 5/10/26 |
| Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Disease (Commercial, BlueCare, Medicare Advantage, DSNP) – G2123 | 2/25/25 | 4/25/25 |
| Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Disease (FEP) – G2123 | 2/25/25 | 4/25/25 |
| Serum Testing for Evidence of Mild Traumatic Brain Injury (Commercial, BlueCare, Medicare Advantage, DSNP) – G2151 | 2/25/25 | 4/25/25 |
| Serum Testing for Evidence of Mild Traumatic Brain Injury (FEP) – G2151 | 2/25/25 | 4/25/25 |
| Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease (Commercial, BlueCare, Medicare Advantage, DSNP) – G2110 | 2/25/25 | 4/25/25 |
| Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease (FEP) – G2110 | 2/25/25 | 4/25/25 |
| Serum Tumor Markers for Malignancies (Commercial, BlueCare) – G2124 | 4/22/25 | 6/25/25 |
| Serum Tumor Markers for Malignancies (FEP) – G2124 | 2/25/25 | 4/25/25 |
| Serum Tumor Markers for Malignancies (Medicare Advantage, DSNP) – G2124 | 2/25/25 | 4/25/25 |
| Testing for Alpha-1 Antitrypsin Deficiency (Commercial, BlueCare, Medicare Advantage, DSNP) – M2068 | 2/25/25 | 4/25/25 |
| Testing for Alpha-1 Antitrypsin Deficiency (FEP) – M2068 | 2/25/25 | 4/25/25 |
| Testing for Diagnosis of Active or Latent Tuberculosis (BlueCare) - G2063 | 4/22/25 | 6/25/25 |
| Testing for Diagnosis of Active or Latent Tuberculosis (Commercial, Medicare Advantage, DSNP) – G2063 | 2/25/25 | 4/25/25 |
| Testing for Diagnosis of Active or Latent Tuberculosis (FEP) – G2063 | 2/25/25 | 4/25/25 |
| Testing for Vector-borne Infections (Commercial, BlueCare, Medicare Advantage, DSNP) – G2158 | 2/25/25 | 4/25/25 |
| Testing for Vector-borne Infections (FEP)– G2158 | 2/25/25 | 4/25/25 |
| Testing of Homocysteine Metabolism – Related Conditions (Commercial, BlueCare, Medicare Advantage, DSNP) – M2141 | 1/15/26 | 3/15/26 |
| Testing of Homocysteine Metabolism – Related Conditions (FEP) – M2141 | 1/15/26 | 3/15/26 |
| Testosterone (Commercial, BlueCare, Medicare Advantage, DSNP) – G2013 | 1/15/26 | 3/15/26 |
| Testosterone (FEP) – G2013 | 1/15/26 | 3/15/26 |
| Therapeutic Drug Monitoring for 5-Fluorouracil (Commercial, BlueCare, Medicare Advantage, DSNP) – M2067 | 1/15/26 | 3/15/26 |
| Therapeutic Drug Monitoring for 5-Fluorouracil (FEP) – M2067 | 1/15/26 | 3/15/26 |
| Thyroid Disease Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2045 | 3/10/26 | 5/10/26 |
| Thyroid Disease Testing (FEP) – G2045 | 3/10/26 | 5/10/26 |
| Urinary Tumor Markers for Bladder Cancer (BlueCare) – G2125 | 3/10/26 | 5/10/26 |
| Urinary Tumor Markers for Bladder Cancer (Commercial) – G2125 | 3/10/26 | 5/10/26 |
| Urinary Tumor Markers for Bladder Cancer (FEP) – G2125 | 3/10/26 | 5/10/26 |
| Urinary Tumor Markers for Bladder Cancer (Medicare Advantage, DSNP) – G2125 | 3/10/26 | 5/10/26 |
| Urine Culture Testing for Bacteria (Commercial, BlueCare, Medicare Advantage, DSNP) – G2156 | 2/25/25 | 4/25/25 |
| Urine Culture Testing for Bacteria (FEP) – G2156 | 2/25/25 | 4/25/25 |
| Venous and Arterial Thrombosis Risk Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – M2041 | 3/10/26 | 5/10/26 |
| Venous and Arterial Thrombosis Risk Testing (FEP) – M2041 | 3/10/26 | 5/10/26 |
| Vitamin B12 and Methylmalonic Acid Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2014 | 1/15/26 | 3/15/26 |
| Vitamin B12 and Methylmalonic Acid Testing (FEP) – G2014 | 1/15/26 | 3/15/26 |
| Vitamin D Testing (Commercial, BlueCare, Medicare Advantage, DSNP) – G2005 | 1/15/26 | 3/15/26 |
| Vitamin D Testing (FEP) – G2005 | 1/15/26 | 3/15/26 |