| Carelon Medical Benefits Management | Joint Surgery 2025-11-15 | 2025-11-15 |
| Carelon Medical Benefits Management | Sacroiliac Joint Fusion 2025-11-15 updated 2026-01-01 | 2025-11-15 |
| Carelon Medical Benefits Management | Small Joint Surgery 2025-11-15 | 2025-11-15 |
| Carelon Medical Benefits Management | Spine Surgery 2025-11-15 updated 2026-01-01 | 2025-11-15 |
| Carelon Medical Benefits Management | Imaging of the Brain 2025-11-15 updated 2026-01-01 | 2025-11-15 |
| Carelon Medical Benefits Management | Imaging of the Extremities 2025-11-15 | 2025-11-15 |
| Carelon Medical Benefits Management | Imaging of the Spine 2025-11-15 | 2025-11-15 |
| Carelon Medical Benefits Management | Oncologic Imaging 2025-11-15 [for Amerigroup Georgia Medicaid] | 2025-11-15 |
| Carelon Medical Benefits Management | Sleep Disorder Management 2025-11-15 updated 2026-03-21 | 2025-11-15 |
| Carelon Medical Benefits Management | Level of Care for Surgical Procedures 2025-11-15 | 2025-11-15 |