| Ambetter Health Illinois Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Ambetter Health Illinois Clinical | Facet Joint Interventions | 2025-05-01 |
| Ambetter Health Illinois Clinical | Fecal Incontinence Treatments | 2025-05-01 |
| Ambetter Health Illinois Clinical | Neuromuscular Electrical Stimulation (NMES) | 2025-05-01 |
| Ambetter Health Illinois Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Ambetter Health Illinois Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Ambetter Health Illinois Clinical | Total Artificial Heart | 2025-05-01 |
| Ambetter Health Indiana Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Ambetter Health Indiana Clinical | Biofeedback for Behavioral Health Disorders | 2025-05-01 |
| Ambetter Health Indiana Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |