| BCBS Highmark Delaware | Electroretinography | 2023-10-01 |
| BCBS Highmark Delaware | External Counterpulsation | 2023-10-01 |
| BCBS Highmark Delaware | Repository Corticotropin Intramuscular Injection (Acthar Gel) | 2023-10-01 |
| BCBS Highmark West Virginia | Vision Therapy (Orthoptics and Pleoptics) | 2023-10-01 |
| BCBS Highmark West Virginia | Cognitive Rehabilitation | 2023-10-01 |
| BCBS Highmark West Virginia | Electroretinography | 2023-10-01 |
| BCBS Highmark West Virginia | External Counterpulsation | 2023-10-01 |
| BCBS Highmark West Virginia | Repository Corticotropin Intramuscular Injection (Acthar Gel) | 2023-10-01 |
| Ambetter Health Texas Superior Medicaid Clinical | Severe Malnutrition (CC.PP.145) | 2023-10-01 |
| Ambetter Health Texas Superior Marketplace Clinical | Severe Malnutrition (CC.PP.145) | 2023-10-01 |