| Ambetter Health Texas Superior Marketplace Clinical | Short Inpatient Hospital Stay | 2025-02-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | 2025-02-01 |
| Ambetter Health Texas Superior Marketplace Clinical | ADAMTS13, Recombinant-krhn | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Donor Lymphocyte Infusion | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Heart-Lung Transplant | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Implantable Wireless Pulmonary Artery Pressure Monitoring | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Lung Transplantation | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Nerve Blocks | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Pediatric Kidney Transplant | 2025-02-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition | 2025-02-01 |