Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways


Guidelines for imaging modalities, including CT, MRI, MRA, PET, arterial ultrasound, and nuclear scintigraphy.


Guidelines for cardiac imaging modalities, including echocardiography, nuclear cardiology, cardiac CT, cardiac MRI, and cardiac PET.


Guidelines for testing and treatment of sleep disorders, including obstructive sleep apnea.


Guidelines for spine surgeries, joint surgeries, and interventional pain management.


Guidelines for physical therapy, occupational therapy, and speech therapy.

Genetic Testing

Guidelines for genetic testing, including for pharmacogenomics, prenatal diagnosis, cardiac disease, cancer susceptibility, and tumors and malignancies.

Radiation Oncology

Guidelines for radiation therapies, including brachytherapy, image-guided radiotherapy, intensity-modulated radiation therapy, proton beam therapy, and therapeutic radiopharmaceuticals.

Cancer Treatment Pathways and Guidelines

Cancer treatment pathways and guidelines for common types of cancer, including breast cancer, colorectal cancer, prostate cancer, melanoma, lung cancer, and lymphoma.

New and Emerging Interventions

Guidelines for new and emerging healthcare interventions defined as drugs, devices, tests, or procedures.


Guideline outlines the clinical appropriateness framework for diagnostic and therapeutic interventions addressed in Carelon guidelines, simultaneous ordering, repeat intervention, and interventions not otherwise addressed in specific Carelon guidelines.

Please email us for any questions about guidelines.

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