| Wellcare Michigan Medicare Clinical | Cosmetic and Reconstructive Procedures | 2024-08-01 |
| Wellcare Michigan Medicare Clinical | Allogeneic Hematopoietic Cell Transplants for Sickle Cell | 2024-08-01 |
| Wellcare Michigan Medicare Clinical | Sacroiliac Joint Interventions for Pain Management | 2024-08-01 |
| Wellcare Rhode Island Medicare Clinical | Cosmetic and Reconstructive Procedures | 2024-08-01 |
| Wellcare Rhode Island Medicare Clinical | Allogeneic Hematopoietic Cell Transplants for Sickle Cell | 2024-08-01 |
| Wellcare Rhode Island Medicare Clinical | Sacroiliac Joint Interventions for Pain Management | 2024-08-01 |
| Wellcare South Carolina Medicare Clinical | Cosmetic and Reconstructive Procedures | 2024-08-01 |
| Wellcare South Carolina Medicare Clinical | Allogeneic Hematopoietic Cell Transplants for Sickle Cell | 2024-08-01 |
| Wellcare South Carolina Medicare Clinical | Sacroiliac Joint Interventions for Pain Management | 2024-08-01 |
| Wellcare Hawai'i Medicaid Clinical | Cosmetic and Reconstructive Procedures | 2024-08-01 |