| Ambetter Health Arizona Clinical | Immobilized Lipase Cartridges (Relizorb) | 2026-02-01 |
| Ambetter Health Indiana Clinical | Assisted Reproductive Technology | 2026-02-01 |
| Ambetter Health Indiana Clinical | Immobilized Lipase Cartridges (RELiZORB) (CP.MP.252) | 2026-02-01 |
| Ambetter Health Michigan Meridian Clinical | Immobilized Lipase Cartridges (RELiZORB) | 2026-02-01 |
| Ambetter Health Nevada Silver Summit Clinical | Assisted Reproductive Technology | 2026-02-01 |
| Ambetter Health Nevada Silver Summit Clinical | Immobilized Lipase Cartridges (Relizorb) | 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 |