| Wellcare Hawai'i Medicaid Clinical | Neuromuscular and Peroneal Nerve Electrical | 2025-05-01 |
| Wellcare Hawai'i Medicaid Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Wellcare Hawai'i Medicaid Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Wellcare Hawai'i Medicaid Clinical | Total Artificial Heart | 2025-05-01 |
| Wellcare Hawai'i Medicare Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Wellcare New Jersey Medicaid Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Wellcare New Jersey Medicaid Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Wellcare New York Medicare Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Allogeneic Hematopoietic Progenitor Cell Therapy | 2025-05-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |