| Wellcare New Jersey Medicaid Clinical | Stereotactic Body Radiation Therapy | 2024-10-01 |
| Wellcare New Jersey Medicare Clinical | Concert Genetic Testing: Pharmacogenetics (Version B) | 2024-10-01 |
| Wellcare Iowa Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2024-10-01 |
| Wellcare Iowa Medicare Clinical | Concert Genetic Testing: Pharmacogenetics (Version B) | 2024-10-01 |
| Wellcare New York Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2024-10-01 |
| Wellcare New York Medicare Clinical | Concert Genetic Testing: Pharmacogenetics (Version B) | 2024-10-01 |
| BCBS Florida Coverage Guidelines | Intravenous Lidocaine for the Management of (09-J0000-65) | 2024-10-01 |
| BCBS Florida Coverage Guidelines | Levoleucovorin (Fusilev® and Khapzory™) IV (09-J2000-31) | 2024-10-01 |
| BCBS Florida Coverage Guidelines | Pralatrexate (Folotyn™) IV (09-J1000-18) | 2024-10-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Mechanical Stretching Devices for Joint Stiffness and Contracture | 2024-10-01 |