| Ambetter Health Louisiana Clinical | Immobilized Lipase Cartridges (RELiZORB®) (CP.MP.252) | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Implantable Wireless Pulmonary Artery Pressure Monitoring | 2026-02-01 |
| Ambetter Health Louisiana Clinical | IMRT | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Lung Transplantation | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Nerve Blocks | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Outpatient Cardiac Rehabilitation | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Pediatric Kidney Transplant | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other | 2026-02-01 |
| Ambetter Health Nebraska Clinical | Immobilized Lipase Cartridges (Relizorb) (CP.MP.252) | 2026-02-01 |
| Ambetter Health Nebraska Clinical | Transcranial Magnetic Stimulation for Treatment Resistant Major Depression | 2026-02-01 |