| BCBS Minnesota | Sacral Nerve Neuromodulation/Stimulation for Selected Conditions | 2025-09-01 |
| BCBS Minnesota | Plasma Exchange | 2025-09-01 |
| BCBS Minnesota | Optical Coherence Tomography of the Anterior Eye Segment | 2025-09-01 |
| BCBS Minnesota | Peripheral Nerve Stimulation of the Trunk or Limbs for Treatment of Pain | 2025-09-01 |
| BCBS Minnesota | Remote Electrical Neuromodulation for Migraines | 2025-09-01 |
| BCBS Minnesota | Hematopoietic Stem Cell Transplantation in the Treatment of Germ-Cell Tumors | 2025-09-01 |
| BCBS Minnesota | Hematopoietic Stem Cell Transplantation for Solid Tumors of Childhood | 2025-09-01 |
| Sentara Health Plans | External Insulin Infusion Pump, DME 11 - Commercial | 2025-09-01 |
| Sentara Health Plans | External Insulin Infusion Pump, DME 11 - Medicaid | 2025-09-01 |
| Sentara Health Plans | ARTS Family Support Partners, BH 41 - Medicaid | 2025-09-01 |