Carelon Medical Benefits Management (formerly AIM Specialty Health) Clinical Appropriateness Guidelines CPT code list update

Effective for dates of service on and after June 1, 2023, the following code updates will apply to the Carelon Medical Benefits Management, Inc.* Radiology Clinical Appropriateness Guidelines.

Advanced imaging of the abdomen and pelvis

CPT® code	Description
0648T	Quantitative magnetic resonance for analysis of tissue composition (for example, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation, and report, obtained without diagnostic MRI examination of the same anatomy (for example, organ, gland, tissue, target structure) during the same session.

 

Oncologic imaging

CPT code	Description
0633T	CT Breast W/3d Rendering Uni without contrast
0634T	CT Breast W/3d Rendering Uni with contrast
0635T	CT Breast W/3d Rendering Uni with or without contrast
0636T	CT Breast W/3d Rendering Bi without contrast
0637T	CT Breast W/3d Rendering Bi with contrast
0638T	CT Breast W/3d Rendering Bi with or without contrast

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon in one of several ways:

• Access the ProviderPortal_SM directly at providerportal.com.
  • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
• Access the Availity* website at availity.com.

 

If you have questions related to guidelines, please contact Carelon via email at MedicalBenefitsManagement.guidelines@carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Carelon Medical Benefits Management, Inc. is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.

COBCBS-CR-13581-22-CPN12763