Carelon Medical Benefits Management, Inc. updates

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 Guidelines:
  • Interventional Pain Management

Effective for dates of service on and after June 30, 2024, the following Carelon Medical Benefits Management Clinical Appropriateness Guideline updates for medical necessity review will apply for Anthem:

• Genetic Testing:
  • Hereditary Cancer Testing
  • Carrier Screening in the Prenatal Setting and Preimplantation Genetic Testing
  • Genetic Testing for Inherited Conditions

Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff.