| BCBS Minnesota | Infusion or Injection of Vitamins and/or Minerals | 2025-12-01 |
| BCBS Minnesota | Air Ambulance | 2025-12-01 |
| BCBS Minnesota | Anesthesia Services for Dental Procedures | 2025-12-01 |
| BCBS Minnesota | Digital Therapeutics for Amblyopia | 2025-12-01 |
| BCBS Minnesota | Nonpharmacologic Treatment of Rosacea | 2025-12-01 |
| BCBS Minnesota | Hematopoietic Stem Cell Transplantation for Autoimmune Disease | 2025-12-01 |
| Sentara Health Plans | Scalp Cooling During Chemotherapy, DME 249 - Commercial | 2025-12-01 |
| Sentara Health Plans | Scalp Cooling During Chemotherapy, DME 249 - Medicaid | 2025-12-01 |
| Sentara Health Plans | Implantable Hemodynamic Monitoring for - Commercial | 2025-12-01 |
| Sentara Health Plans | Implantable Hemodynamic Monitoring for - Medicaid | 2025-12-01 |