| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Intestinal and Multivisceral Transplant | 2025-04-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Liposuction for Lipedema | 2025-04-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Lysis of Epidural Lesions | 2025-04-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Therapeutic Utilization of Inhaled Nitric Oxide | 2025-04-01 |
| Sunshine Health Clinical Policy | Pediatric Oral Function Therapy | 2025-04-01 |
| Sunshine Health Clinical Policy | Repair of Nasal Valve Compromise | 2025-04-01 |
| Sunshine Health Clinical Policy | Sacroiliac Joint Fusion | 2025-04-01 |
| BCBS Iowa Medical Policies | Hematopoietic Stem Cell Transplantation Autologous and Allogeneic* | 2025-04-01 |
| BCBS Massachusetts | Adjunctive Techniques for Screening and Surveillance and Risk Classification of Barrett Esophagus and Esophageal Dysplasia | 2025-04-01 |
| BCBS Massachusetts | Air Ambulance Transport | 2025-04-01 |