| Health Net Comm & Medi-Cal Plan | Panniculectomy | 2025-08-01 |
| Health Net Comm & Medi-Cal Plan | Pediatric Heart Transplant | 2025-08-01 |
| Health Net Comm & Medi-Cal Plan | Radiation Therapy for Skin Cancer | 2025-08-01 |
| Sentara Health Plans | Prosthetic Devices, DME 21 - Commercial | 2025-08-01 |
| Sentara Health Plans | Prosthetic Devices, DME 21 - Medicaid | 2025-08-01 |
| Sentara Health Plans | Ultraviolet Light Therapy System - Commercial | 2025-08-01 |
| Sentara Health Plans | Ultraviolet Light Therapy System - Medicaid | 2025-08-01 |
| Sentara Health Plans | 23-Hour Crisis Stabilization, BH 33 - Medicaid | 2025-08-01 |
| Sentara Health Plans | Community Stabilization, BH 32 - Medicaid | 2025-08-01 |
| Sentara Health Plans | Mental Health Intensive Outpatient Services (MH-IOP), - Medicaid | 2025-08-01 |