Carelon Medical Benefits Management, Inc. updates effective October 20, 2024

Effective on October 20, 2024, the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guideline updates for medical necessity review, will apply for Anthem. This article is to communicate the plan adoption of these Carelon Medical Benefits Management, Inc. guidelines. This does not equate to the presence of a prior authorization requirement. 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.

• Genetic Testing:
  • Pharmacogenomic Testing
  • Predictive and Prognostic Polygenic Testing
  • Chromosomal Microarray Analysis
  • Whole Exome Sequencing and Whole Genome Sequencing
  • Somatic Tumor Testing

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