Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 7, 2023

Carelon Medical Benefits Management, Inc Spine & Joint Surgery Guideline Update

Carelon Medical Benefits Management, Inc. Guideline Update

The Carelon Medical Benefits Management, Inc.* guidelines below were developed and/or revised effective September 11, 2023. The guidelines were revised to provide clarification only related to the updated criteria. Existing precertification requirements have not changed. 

Please share this notice with other providers in your practice and office staff.

To view a guideline, visit https://guidelines.carelonmedicalbenefitsmanagement.com/

Criteria number

Criteria title

New or revised

MSK03-0923.2

Carelon Medical Benefits Management spine surgery clinical appropriateness guideline — criteria for lumbar disc arthroplasty

Revised

MSK02-1123.1

Carelon Medical Benefits Management joint surgery clinical appropriateness guideline — criteria for meniscal allograft transplantation of the knee and osteochondral grafts

Revised

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

INBCBS-CD-025997-23

PUBLICATIONS: October 2023 Provider Newsletter