| BCBS Montana Medical Policies | Removal of Ascites via Implantable Pump | 2024-07-01 |
| BCBS Montana Medical Policies | Temporomandibular Joint (TMJ) Disorders (TMJD) | 2024-07-01 |
| Ambetter Health Iowa Clinical | Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy | 2024-07-01 |
| Ambetter Health Illinois Clinical | Gender-Affirming Procedures | 2024-07-01 |
| Ambetter Health Illinois Clinical | Intradiscal Steroid Injections | 2024-07-01 |
| Ambetter Health Illinois Clinical | Sacroiliac Joint Interventions | 2024-07-01 |
| Ambetter Health Indiana Clinical | Intradiscal Steroid Injections | 2024-07-01 |
| Ambetter Health Indiana Clinical | Sacroiliac Joint Interventions | 2024-07-01 |
| Ambetter Health Michigan Meridian Clinical | Sacroiliac Joint Interventions | 2024-07-01 |
| Ambetter Health Mississippi Magnolia Clinical | Diaphragmatic/Phrenic Nerve Stimulation | 2024-07-01 |