| BCBS Montana Medical Policies | Daily Hemodialysis and Hemodialysis in the Home Setting | 2025-04-01 |
| BCBS Montana Medical Policies | Gait Analysis | 2025-04-01 |
| BCBS Montana Medical Policies | Laser Treatment of Vulvovaginal Atrophy (VVA) | 2025-04-01 |
| BCBS Montana Medical Policies | Magnetoencephalography (MEG) and Magnetic Source | 2025-04-01 |
| BCBS Montana Medical Policies | Transanal Endoscopic Microsurgery | 2025-04-01 |
| Sunshine Health Clinical Policy | Disc Decompression Procedures | 2025-04-01 |
| Sunshine Health Clinical Policy | Discography | 2025-04-01 |
| Sunshine Health Clinical Policy | Liposuction for Lipedema | 2025-04-01 |
| Sunshine Health Clinical Policy | Multiple Sleep Latency Testing | 2025-04-01 |
| Ambetter Health Florida Clinical | Sacroiliac Joint Fusion | 2025-04-01 |