| Ambetter Health Louisiana Clinical | Concert Genetic Testing: Toxicology and Pharmacogenetics (Version B) (V2.2025) | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Concert Genetic Testing: Transplant (V2.2025) | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Hyperhidrosis Treatments | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Implantable Intrathecal or Epidural Pain Pump | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Implantable Loop Recorder | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Obstetrical Home Care Programs | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Orthognathic Surgery | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Outpatient Oxygen Use | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Proton and Neutron Beam Therapies | 2025-11-01 |
| Ambetter Health Louisiana Clinical | Selective Dorsal Rhizotomy in CP | 2025-11-01 |