| Ambetter Health Kentucky WellCare Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Ambetter Health Kentucky WellCare Clinical | Facet Joint Interventions | 2025-05-01 |
| Ambetter Health Kentucky WellCare Clinical | Fecal Incontinence Treatments | 2025-05-01 |
| Ambetter Health Kentucky WellCare Clinical | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | 2025-05-01 |
| Ambetter Health Kentucky WellCare Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Ambetter Health Kentucky WellCare Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Ambetter Health Kentucky WellCare Clinical | Total Artificial Heart | 2025-05-01 |
| Ambetter Health Michigan Meridian Clinical | Biofeedback for Behavioral Health Disorders | 2025-05-01 |
| Ambetter Health Michigan Meridian Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |
| Ambetter Health Michigan Meridian Clinical | Cochlear Implant Replacements | 2025-05-01 |