Policy Updates Medical Policy & Clinical GuidelinesMedicaidJanuary 3, 2024

Carelon Medical Benefits Management, Inc. updates

The Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines below have been updated. Existing precertification requirements have not changed.

Please share this notice with other members of your practice and office staff.

Effective for dates of service on and after April 14, 2024, the following updates will apply to the Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity review for Anthem Blue Cross:

  • Musculoskeletal Guidelines:
    • Interventional Pain Management
    • Sacroiliac Joint Fusion
  • Radiology:
    • Imaging of the Chest
    • Imaging of the Head and Neck
    • Imaging of the Brain
    • Oncologic Imaging
    • Imaging of the Abdomen and Pelvis
    • Imaging of the Heart
  • Radiation Oncology:
    • Proton Beam Therapy
    • Perirectal Hydrogel Spacer for Prostate Radiotherapy
  • Rehabilitation:
    • Physical, Occupational, and Speech Therapies

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CD-047280-23-CPN46505

PUBLICATIONS: February 2024 Provider Newsletter