| Wellcare Hawai'i Medicare Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Wellcare New Jersey Medicaid Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Wellcare New Jersey Medicaid Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Wellcare New York Medicare Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Facet Joint Interventions | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Fecal Incontinence Treatments | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | 2025-05-01 |