Carelon Medical Benefits Management, Inc. updates

Effective on May 1, 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.

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

The following guideline updates have a publish date of March 23, 2025:

• Genetic Testing:
• Carrier Screening in the Reproductive Setting
• Genetic Testing for Inherited Conditions
• Hereditary Cancer Testing
• Radiation Oncology:
• Perirectal Hydrogel Spacer for Prostate Radiotherapy
• Proton Beam Therapy
• Radiation Therapy (excludes Proton)

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