| Ambetter Health Louisiana Clinical | Fecal Incontinence Treatments | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Fetal Surgery in Utero for Prenatally Diagnosed Malformations | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |
| Ambetter Health Louisiana Clinical | Total Artificial Heart | 2025-05-01 |
| Wellcare Hawaii Medicaid Clinical | Caudal or Interlaminar Epidural Steroid Injections | 2025-05-01 |
| Wellcare Hawaii Medicaid Clinical | Cochlear Implant Replacements | 2025-05-01 |
| Wellcare Hawaii Medicaid Clinical | Fetal Surgery in Utero for Prenatally Diagnosed | 2025-05-01 |
| Wellcare Hawaii Medicaid Clinical | Pediatric Liver Transplant | 2025-05-01 |
| Wellcare Hawaii Medicaid Clinical | Reduction Mammoplasty and Gynecomastia Surgery | 2025-05-01 |