| Sentara Health Plans Avalon | M2182: Genomic Testing for Hematopoietic Neoplasms | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Adopted Clinical Practice and Preventive Health Guidelines (CPG Grid) | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Assisted Reproductive Technology | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Bariatric Surgery | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Donor Lymphocyte Infusion | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Heart-Lung Transplant | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Home Ventilators | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Immobilized Lipase Cartridges (RELiZORB®) (CP.MP.252) | 2026-02-01 |
| Ambetter Health Louisiana Clinical | Implantable Wireless Pulmonary Artery Pressure Monitoring | 2026-02-01 |
| Ambetter Health Louisiana Clinical | IMRT | 2026-02-01 |