| Ambetter Health Illinois Clinical | DME and O&P Criteria | 2024-11-01 |
| Ambetter Health Illinois Clinical | Hyperhidrosis Treatments | 2024-11-01 |
| Ambetter Health Illinois Clinical | Implantable Hypoglossal Nerve Stimulation | 2024-11-01 |
| Ambetter Health Illinois Clinical | Implantable Intrathecal or Epidural Pain Pump | 2024-11-01 |
| Ambetter Health Illinois Clinical | Implantable Loop Recorder | 2024-11-01 |
| Ambetter Health Illinois Clinical | Obstetrical Home Care Programs | 2024-11-01 |
| Ambetter Health Illinois Clinical | Outpatient Oxygen Use | 2024-11-01 |
| Ambetter Health Illinois Clinical | Proton and Neutron Beam Therapies | 2024-11-01 |
| Ambetter Health Illinois Clinical | Selective Dorsal Rhizotomy in CP | 2024-11-01 |
| Ambetter Health Illinois Clinical | Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation | 2024-11-01 |