Current | Carelon Clinical Guidelines and Pathways

Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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Current

Percutaneous Coronary Intervention 2024-10-20 updated 2025-01-01

Perirectal Hydrogel Spacer 2025-03-23

Perirectal Hydrogel Spacer for Prostate Radiotherapy 2021-11-07 [for Healthy Blue Louisiana Medicaid and Premera]

Permanent Implantable Pacemakers 2024-03-17 [for Healthy Blue Louisiana Medicaid]

Permanent Implantable Pacemakers 2024-10-20

Pharmacogenomic Testing 2024-10-20 updated 2025-04-01

Physical Therapy, Occupational Therapy, and Speech Therapy 2024-04-14

Predictive and Prognostic Polygenic Testing 2024-10-20 updated 2025-04-01

Prenatal Screening using Cell-free DNA 2024-11-17 updated 2025-04-01

Proton Beam Therapy 2022-03-13 [for Healthy Blue Louisiana Medicaid and Premera]

Proton Beam Therapy 2025-03-23

Radiation Therapy (excludes Proton) 2023-04-09 [for Healthy Blue Louisiana Medicaid]

Radiation Therapy (excludes Proton) 2024-10-20 [for Premera]

Radiation Therapy (excludes Proton) 2025-03-23

Sacroiliac Joint Fusion 2024-01-01 [for Healthy Blue Louisiana Medicaid]

Sacroiliac Joint Fusion 2024-10-20 updated 2025-01-01

Site of Care for Advanced Imaging 2024-11-17

Site of Care for Physical, Occupational, and Speech Therapies 2023-12-30

Site of Care for Surgical Procedures 2024-11-17

Skilled Nursing Facility Level of Care 2024-09-01

Sleep Disorder Management 2023-09-10 [for Healthy Blue Louisiana Medicaid]

Sleep Disorder Management 2024-10-20 updated 2025-04-01

Small Joint Surgery 2024-01-01 [for Healthy Blue Louisiana Medicaid]

Small Joint Surgery 2024-11-17

Somatic Tumor Testing 2024-11-17 updated 2025-01-01 [for Healthy Blue Ohio Medicaid]

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