| BCBS Massachusetts | Tibial Nerve Stimulation | 2025-10-01 |
| BCBS Massachusetts | Transcatheter Tricuspid Valve Repair or Replacement | 2025-10-01 |
| BCBS Massachusetts | Uterus Transplantation for Absolute Uterine Factor Infertility | 2025-10-01 |
| BCBS Massachusetts | Vitamin D Assay Testing | 2025-10-01 |
| BCBS South Dakota Medical Policies | Miscellaneous Minimally Invasive Treatments for Benign Prostatic Hyperplasia | 2025-10-01 |
| BCBS South Dakota Medical Policies | Orally Ingested Transient Device for Constipation | 2025-10-01 |
| BCBS South Dakota Medical Policies | Vascular Endothelial Growth Factor (VEGF) Inhibitors for Ophthalmic Use | 2025-10-01 |
| Ambetter Health Arizona Clinical | Electric Tumor Treating Fields | 2025-10-01 |
| Ambetter Health Arizona Clinical | Mechanical Stretching Devices for Joint Stiffness and Contracture | 2025-10-01 |
| Ambetter Health Arizona Clinical | Skin and Soft Tissue Substitutes for Chronic Wounds | 2025-10-01 |