Carelon Medical Benefits Management, Inc. updates

Effective on July 28, 2025, the following Carelon Medical Benefits Management Clinical Appropriateness Guideline updates will be adopted for Anthem. This article is to communicate the plan adoption of these guidelines. Existing prior authorization requirements have not changed. In the event a prior authorization requirement for these services will be implemented, a separate notice will be distributed before the addition of any prior authorization requirements.

The following guideline updates have a publish date of July 26, 2025:

• Genetic Testing
• Chromosomal Microarray Analysis
• Pharmacogenomic Testing
• Whole Exome Sequencing and Whole Genome Sequencing
• Musculoskeletal
• Interventional Pain Management

You may access and download a copy of the current and upcoming guidelines here.

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