Policy Updates Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageMedicaidDecember 28, 2023

Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Effective April 1, 2024, requested cardiology interventions will be transitioned to the following Carelon Medical Benefits Management, Inc. guidelines for medical necessity/clinical appropriateness reviews. Applicable CPT® codes lists are included in each guideline linked below:

Preapproval requirements remain the same. The requested services received on or after April 1, 2024, will be reviewed with the new Clinical Criteria.

As a reminder, ordering and servicing care providers may submit preapproval requests to Carelon Medical Benefits Management using the ProviderPortalSM 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.

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

We are focused on reducing administrative burdens, so you can do what you do best — care for our members.

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

Medicaid services provided by Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Medicare services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC., or Anthem Blue Cross and Blue Shield Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Commercial services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., or Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NYBCBS-CDCRCM-042156-23-CPN41724

PUBLICATIONS: January 2024 Provider Newsletter