Carelon Medical Benefits Management, Inc. updates

The Carelon Medical Benefits Management 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 Clinical Appropriateness Guidelines for medical necessity review for Anthem:

• Musculoskeletal:
  • 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