| BCBS Louisiana | Manipulation Under Anesthesia | 2025-05-01 |
| BCBS Louisiana | Bevacizumab Products | 2025-05-01 |
| BCBS Federal Medical & Drug | 2.04.82 Genetic Testing for Inherited Thrombophilia | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Biofeedback for Behavioral Health Disorders | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Facet Joint Interventions | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Fecal Incontinence Treatments | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |