| BCBS Iowa Medical Policies | Saliva Hormone Tests | 2023-08-01 |
| BCBS South Dakota Medical Policies | Artificial Urinary Sphincter | 2023-08-01 |
| BCBS South Dakota Medical Policies | Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions | 2023-08-01 |
| BCBS South Dakota Medical Policies | Neurofeedback | 2023-08-01 |
| BCBS South Dakota Medical Policies | Saliva Hormone Tests | 2023-08-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds (CC.PP.061) | 2023-08-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds (CC.PP.061) | 2023-08-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Endometrial Ablation | 2023-08-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds (CC.PP.061) | 2023-08-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Intensity Modulated Radiation Therapy (IMRT) | 2023-08-01 |