Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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ARCHIVED Imaging of the Chest 2024-04-14 to 2025-03-22

Archive Date: 03/23/2025; Archived for Premera: 04/20/2025 This document has been archived because it has outdated information. It is for historical information only and should not be consulted for clinical use. Current versions of guidelines are available on the...

Perirectal Hydrogel Spacer 2025-03-23

Link to PDF Status: Revised Effective Date: 03/23/2025 Doc ID: RAD04-0325.1 Last Review Date: 07/16/2024 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. Clinical Appropriateness...

Proton Beam Therapy 2025-03-23

Link to PDF Status: Revised Effective Date: 03/23/2025 Doc ID: RAD01-0325.1 Last Review Date: 07/16/2024 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. Clinical Appropriateness...

Radiation Therapy (excludes Proton) 2025-03-23

Link to PDF Status: Revised Effective Date: 03/23/2025 Doc ID: RAD02-0325.1 Last Review Date: 07/16/2024 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. Clinical Appropriateness...