| Buckeye Health Plan Ohio Medicaid Clinical | Scanning Computerized Opthalmic Diagnostic | 2020-11-01 |
| Buckeye Health Plan Ohio Medicaid Clinical | Visual Field Testing | 2020-11-01 |
| BCBS Iowa Medical Policies | High Dollar Drug Review | 2020-10-01 |
| BCBS Iowa Medical Policies | Off-label Drug Use | 2020-10-01 |
| BCBS South Dakota Medical Policies | High Dollar Drug Review | 2020-10-01 |
| BCBS South Dakota Medical Policies | Off-label Drug Use | 2020-10-01 |
| BCBS Highmark Penn Medicare Advantage | Refractive Lenses | 2020-10-01 |
| Sunshine Health Clinical Policy | External Ocular Photography | 2020-10-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Drugs of Abuse: Presumptive Testing | 2020-10-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Renal Hemodialysis (CC.PP.067) | 2020-09-29 |