AdministrativeHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 18, 2025

Guideline update for Carelon Medical Benefits Management, Inc.

The guidelines below were developed and/or revised and became effective December 1, 2024. 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, go here.

Criteria number

Criteria title

CPT® codes

Carelon Medical Benefits Management Clinical Appropriateness Guidelines spine surgery

Carelon Medical Benefits Management musculoskeletal: spine surgery

22857

Carelon Medical Benefits Management Clinical Appropriateness Guidelines joint surgery

Carelon Medical Benefits Management musculoskeletal: joint surgery

27412

27415

27416

29866

29867

29868

28446

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

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-074771-24

PUBLICATIONS: March 2025 Provider Newsletter