| Ambetter Health Nevada Silver Summit Clinical | Immobilized Lipase Cartridges (Relizorb) | 2026-02-01 |
| Ambetter Health Arizona Clinical | Transcranial Magnetic Stimulation for Treatment Resistant Major Depression | 2026-02-01 |
| Ambetter Health Kentucky WellCare Clinical | Immobilized Lipase Cartridges (Relizorb) (CP.MP.252) | 2026-02-01 |
| Ambetter Health Kentucky WellCare Clinical | Transcranial Magnetic Stimulation for Treatment Resistant Major Depression | 2026-02-01 |
| BCBS Louisiana | Treatment of Varicose Veins/Venous Insufficiency | 2026-02-01 |
| BCBS Louisiana | Ophthalmologic Techniques That Evaluate the Posterior Eye Segment for Glaucoma | 2026-02-01 |
| BCBS Louisiana | natalizumab Products | 2026-02-01 |
| BCBS Louisiana | Select infliximab Products | 2026-02-01 |
| BCBS Louisiana | Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus | 2026-02-01 |
| BCBS Louisiana | C1 Esterase Inhibitor (Cinryze®, Haegarda®) | 2026-02-01 |