| Meridian Michigan Medicaid Clinical | Sacroiliac Joint Fusion | 2025-04-01 |
| Meridian Michigan Medicaid Clinical | Therapeutic Utilization of Inhaled Nitric Oxide | 2025-04-01 |
| Buckeye Health Plan Ohio Medicaid Clinical | Bariatric Surgery | 2025-04-01 |
| Buckeye Health Plan Ohio Medicaid Clinical | Transcranial Magnetic Stimulation for Treatment | 2025-04-01 |
| BCBS Louisiana | lebrikizumab-lbkz (Ebglyss™) | 2025-04-01 |
| Sentara Health Plans Avalon | M2067: Therapeutic Drug Monitoring for 5-Fluorouracil | 2025-04-01 |
| Ambetter Health Louisiana Clinical | Transcranial Magnetic Stimulation | 2025-04-01 |
| Ambetter Health Mississippi Magnolia Clinical | Transcranial Magnetic Stimulation | 2025-04-01 |
| Wellcare Hawaii Medicaid Clinical | Intestinal and Multivisceral Transplant | 2025-04-01 |
| Wellcare Hawaii Medicaid Clinical | Sacroiliac Joint Fusion | 2025-04-01 |