| Wellcare Hawai'i Medicaid Clinical | Implantable Loop Recorder | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Outpatient Oxygen Use | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Spinal Cord, Peripheral Nerve, and Percutaneous | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Urinary Incontinence Devices and Treatments | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Ventricular Assist Devices | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Biofeedback | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Burn Surgery | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Durable Medical Equipment and Orthotics and Prosthetics Guidelines | 2024-11-01 |
| Wellcare Hawai'i Medicaid Clinical | Hyperhidrosis Treatments | 2024-11-01 |