| Ambetter Health Louisiana Clinical | NICU Discharge Guidelines | 2025-06-01 |
| Ambetter Health Louisiana Clinical | Osteogenic Stimulation | 2025-06-01 |
| Ambetter Health Louisiana Clinical | Phototherapy for Neonatal Hyperbilirubinemia | 2025-06-01 |
| Ambetter Health Louisiana Clinical | Physical Therapy, Occupational Therapy, Speech Therapy | 2025-06-01 |
| Aetna | Clofarabine (Clolar) | 2025-05-28 |
| Presbyterian Health Plan | Allergen Immunotherapy | 2025-05-28 |
| Presbyterian Health Plan | Allergy Testing | 2025-05-28 |
| Presbyterian Health Plan | Bariatric Surgery for Pediatric Population | 2025-05-28 |
| Presbyterian Health Plan | Investigative & New Technology Assessment List (Non-Covered Services) | 2025-05-28 |
| Presbyterian Health Plan | Durable Medical Equipment: Orthotics and Prosthetics | 2025-05-28 |