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 cardiovascular imaging, coronary interventions, cardiac devices, and vascular interventions.


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.

Post-Acute Care

Guidelines for inpatient rehabilitation, long-term acute care, and skilled nursing facilities.

Surgical Procedures

Guidelines for upper gastrointestinal endoscopy and surgical site of care.

New and Emerging Interventions

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

Information for Medicare beneficiaries enrolled in a Medicare Advantage plan available here.

Please email us for any questions about guidelines.

Requests to consider additional published clinical literature or evidence can be submitted here.

You can access Provider Connections, our news blog for prior authorization staff here.


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