| Wellcare Kentucky Medicare Clinical | Cosmetic and Reconstructive Procedures | 2025-12-01 |
| Wellcare Florida Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2025-12-01 |
| Wellcare Georgia Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2025-12-01 |
| Wellcare Georgia Medicare Clinical | Cosmetic and Reconstructive Procedures | 2025-12-01 |
| Wellcare North Carolina Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2025-12-01 |
| Wellcare North Carolina Medicare Clinical | Cosmetic and Reconstructive Procedures | 2025-12-01 |
| Wellcare Arkansas Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2025-12-01 |
| Wellcare Arkansas Medicare Clinical | Cosmetic and Reconstructive Procedures | 2025-12-01 |
| Wellcare California Medicare Clinical | Stereotactic Radiation Therapy: Stereotactic | 2025-12-01 |
| Wellcare California Medicare Clinical | Cosmetic and Reconstructive Procedures | 2025-12-01 |