Current | Carelon Clinical Guidelines and Pathways

Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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Current

Ambulatory Cardiac Rhythm Monitoring 2024-07-01

Cardiac Resynchronization Therapy 2024-03-17 [for Healthy Blue Louisiana Medicaid]

Cardiac Resynchronization Therapy 2024-10-20

Carrier Screening in the Reproductive Setting 2024-06-30 [for Anthem BCBS Ohio Medicaid]

Carrier Screening in the Reproductive Setting 2025-09-20

Catheter-Based Closure of Patent Foramen Ovale 2024-11-01

Cell-free DNA Testing (Liquid Biopsy) for the Management of Cancer 2024-11-17 updated 2025-10-01 [for Anthem BCBS Ohio Medicaid]

Chromosomal Microarray Analysis 2025-07-26

Diagnostic Coronary Angiography 2023-04-01 updated 2024-04-01 [for Healthy Blue Louisiana Medicaid]

Diagnostic Coronary Angiography 2023-04-01 updated 2024-11-17

Dialysis Access Evaluations 2024-11-01

Electrophysiological Studies 2024-07-01

Endovascular Revascularization 2025-11-15

Febrile Neutropenia Risk 2025-11-15

For Medicare beneficiaries enrolled in a Medicare Advantage plan

Genetic Liquid Biopsy in the Management of Cancer and Cancer Surveillance 2025-11-15

Genetic Testing for Inherited Conditions 2024-06-30 updated 2025-01-20 [for Anthem BCBS Ohio Medicaid]

Genetic Testing for Inherited Conditions 2025-09-20 updated 10-01

Hereditary Cancer Testing 2024-06-30 updated 2025-01-01 [for Anthem BCBS Ohio Medicaid]

Hereditary Cancer Testing 2025-03-23

Imaging of the Abdomen and Pelvis 2023-04-09 [for Healthy Blue Louisiana Medicaid]

Imaging of the Abdomen and Pelvis 2024-04-14 [for Simply Healthcare Florida Medicaid]

Imaging of the Abdomen and Pelvis 2025-03-23

Imaging of the Brain 2023-04-09 [for Healthy Blue Louisiana Medicaid]

Imaging of the Brain 2024-10-20 [for Healthy Blue Ohio Medicaid (and Regence-only deferred to 1/1/26)]

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