| Ambetter Health Nebraska Clinical | Cosmetic and Reconstructive Procedures | 2025-08-01 |
| Ambetter Health Nebraska Clinical | DME and O&P Criteria | 2025-08-01 |
| Ambetter Health Nebraska Clinical | Orthognathic Surgery | 2025-08-01 |
| Ambetter Health Nebraska Clinical | Panniculectomy | 2025-08-01 |
| Ambetter Health Nebraska Clinical | Pediatric Heart Transplant | 2025-08-01 |
| Ambetter Health Nevada Silver Summit Clinical | Orthognathic Surgery | 2025-08-01 |
| Ambetter Health Nevada Silver Summit Clinical | Pediatric Heart Transplant | 2025-08-01 |
| Wellcare Kentucky Medicaid Clinical | Allogeneic Hematopoietic Cell Transplants for Sickle Cell | 2025-08-01 |
| Wellcare North Carolina Medicaid Clinical | Breast Surgeries | 2025-08-01 |
| Wellcare North Carolina Medicaid Clinical | Chiropractic Services | 2025-08-01 |