Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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ARCHIVED Vascular Imaging 2021-09-12 to 2023-03-31 for Indiana Medicaid

70450, 70460, 70470, 70496, 70498, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553,
71250, 71260, 71270, 71275, 71550, 71551, 71552, 71555, 72159, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73206, 73225, 73706, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178,
74181, 74182, 74183, 74185, 75635, 93880, 93882, 93922, 93923, 93924, 93925, 93926, 93930, 93931,
93978, 93979, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936

ARCHIVED Nuclear Medicine Imaging 2021-09-12 to 2022-06-11

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78201, 78202, 78215, 78216, 78226, 78227, 78230, 78231, 78232, 78258, 78261, 78262, 78264, 78265,
78266, 78278, 78290, 78291, 78300, 78305, 78306, 78315, 78445, 78456, 78457, 78458, 78579, 78580,
78582, 78597, 78598, 78600, 78601, 78605, 78606, 78610, 78630, 78635, 78645, 78650, 78660, 78700,
78701, 78707, 78708, 78709, 78725, 78730, 78740, 78761, 78800, 78801, 78802, 78804