| Ambetter Health Texas Superior Medicaid Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Fecal Incontinence Treatments | 2025-05-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | 2025-05-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Sunshine Health Clinical Policy | Neuromuscular Electrical Stimulation (NMES) | 2025-05-01 |
| Sunshine Health Clinical Policy | Pediatric Liver Transplant | 2025-05-01 |