| Ambetter Health Michigan Meridian Clinical | Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation | 2025-11-01 |
| Ambetter Health Mississippi Magnolia Clinical | Orthognathic Surgery | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Allogeneic Hematopoietic Stem-Cell | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Ambulatory Withdrawal Management With | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Ambulatory Withdrawal Management Without | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Blepharoplasty and Blepharoptosis | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Cardiac Biomarker Testing | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Craniofacial Surgery | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Diaphragmatic/Phrenic Nerve Stimulation | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Digital EEG Spike Analysis | 2025-11-01 |