| Wellcare North Carolina Medicaid Clinical | Medically Monitored Inpatient Withdrawal | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Non-Emergency Medical Transportation | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Nursing Equipment and Supplies | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Opioid Treatment Program Service | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Out-of-State Services | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Physical Health Clinical Policy Committee | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Physician Fluoride Varnish Services | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Pulmonary Function Testing | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Reconstructive and Cosmetic Surgery | 2025-11-01 |
| Wellcare North Carolina Medicaid Clinical | Routine Patient Costs Furnished in Connection | 2025-11-01 |