Current | Carelon Clinical Guidelines and Pathways

Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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Current

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 2025-07-01 [for Anthem BCBS Ohio Medicaid (and Regence-only to 12/1/25)]

Sleep Disorder Management 2025-11-15

Small Joint Surgery 2025-11-15

Somatic Tumor Testing 2024-11-17 updated 2025-01-01 [for Anthem BCBS Ohio Medicaid]

Somatic Tumor Testing 2025-11-15

SPECT Imaging 2023-09-10 [for Healthy Blue Louisiana Medicaid]

SPECT Imaging 2024-10-20

Spine Surgery 2024-01-01 [for Healthy Blue Louisiana Medicaid]

Spine Surgery 2024-10-20 [for Anthem BCBS Ohio Medicaid]

Spine Surgery 2025-11-15

Therapeutic Radiopharmaceuticals 2022-11-06 [for Healthy Blue Louisiana Medicaid]

Therapeutic Radiopharmaceuticals 2025-03-23

Transcatheter Ablation for Management of Atrial Fibrillation 2024-07-01

Transcatheter Ablation for Management of Supraventricular and Ventricular Arrhythmias 2024-07-01

Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy) 2024-11-01

Vascular Embolization and Occlusion Procedures 2024-11-01

Vascular Imaging 2023-09-10 [for Healthy Blue Louisiana Medicaid]

Vascular Imaging 2024-10-20 [for Anthem BCBS Ohio Medicaid (and Regence-only to 1/1/26)]

Vascular Imaging 2025-11-15

Wearable Cardioverter Defibrillators 2024-07-01

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