| Health Net Comm & Medi-Cal Plan | DME and O&P Criteria | 2025-08-01 |
| Health Net Comm & Medi-Cal Plan | Panniculectomy | 2025-08-01 |
| Health Net Comm & Medi-Cal Plan | Pediatric Heart Transplant | 2025-08-01 |
| Health Net Comm & Medi-Cal Plan | Radiation Therapy for Skin Cancer | 2025-08-01 |
| HealthPartners | Wheelchairs - mobility assistive equipment (MAE) - | 2025-08-01 |
| Sentara Health Plans | Obstructive Sleep Apnea Devices, DME 250 - Commercial | 2025-08-01 |
| Sentara Health Plans | Obstructive Sleep Apnea Devices, DME 250 - Medicaid | 2025-08-01 |
| Sentara Health Plans | Obstructive Sleep Apnea Devices, DME 250 - Medicare | 2025-08-01 |
| Sentara Health Plans | Prosthetic Devices, DME 21 - Commercial | 2025-08-01 |
| Sentara Health Plans | Prosthetic Devices, DME 21 - Medicaid | 2025-08-01 |