| Ambetter Health Illinois Clinical | Implantable Intrathecal or Epidural Pain Pump | 2025-11-01 |
| Ambetter Health Illinois Clinical | Implantable Loop Recorder | 2025-11-01 |
| Ambetter Health Illinois Clinical | Obstetrical Home Care Programs | 2025-11-01 |
| Ambetter Health Illinois Clinical | Orthognathic Surgery | 2025-11-01 |
| Ambetter Health Illinois Clinical | Outpatient Oxygen Use | 2025-11-01 |
| Ambetter Health Illinois Clinical | Proton and Neutron Beam Therapies | 2025-11-01 |
| Ambetter Health Illinois Clinical | Selective Dorsal Rhizotomy in CP | 2025-11-01 |
| Ambetter Health Illinois Clinical | Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation | 2025-11-01 |
| Ambetter Health Indiana Clinical | Biofeedback | 2025-11-01 |
| Ambetter Health Indiana Clinical | Implantable Intrathecal or Epidural Pain Pump | 2025-11-01 |