| Sunshine Health Clinical Policy | Air Ambulance | 2025-03-01 |
| Sunshine Health Clinical Policy | Home Ventilators | 2025-03-01 |
| Sunshine Health Clinical Policy | Mechanical Stretching Devices for Joint Stiffness and Contracture | 2025-03-01 |
| Ambetter Health Illinois Clinical | Air Ambulance | 2025-03-01 |
| Ambetter Health Illinois Clinical | Home Ventilators | 2025-03-01 |
| Ambetter Health Illinois Clinical | Mechanical Stretching Devices for Joint Stiffness and Contracture | 2025-03-01 |
| Ambetter Health Illinois Clinical | Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention | 2025-03-01 |
| Ambetter Health Illinois Clinical | Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other | 2025-03-01 |
| Ambetter Health Illinois Clinical | Skin and Soft Tissue Substitutes for Chronic Wounds | 2025-03-01 |
| Ambetter Health Indiana Clinical | Drugs of Abuse: Definitive Testing | 2025-03-01 |