Clinical guidelines and pathways
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Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways
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Current
Site of Care for Surgical Procedures 2024-11-17 [updated 2026-01-01]
Skilled Nursing Facility Level of Care 2024-09-01
Sleep Disorder Management 2024-10-20 updated 2025-07-01 [for Anthem BCBS Ohio Medicaid]
Sleep Disorder Management 2025-11-15 [updated 2026-03-21]
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 updated 2026-04-01
SPECT Imaging 2024-10-20
Spine Surgery 2024-10-20 [for Anthem BCBS Ohio Medicaid]
Spine Surgery 2025-11-15 updated 2026-01-01
Testicular Cancer
Theranostics (Therapeutic Radiopharmaceuticals) 2026-04-04
Transcatheter Ablation for Management of Atrial Fibrillation 2024-07-01
Transcatheter Ablation for Management of Supraventricular and Ventricular Arrhythmias 2024-07-01
Treatment of Varicose Veins and Superficial Venous Insufficiency 2026-01-10
Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy) 2026-04-04
Uterine Cancer
Vascular Embolization and Occlusion Procedures 2024-11-01
Vascular Imaging 2024-10-20 [for Anthem BCBS Ohio Medicaid]
Vascular Imaging 2025-11-15 [updated 2026-01-01]
Wearable Cardioverter Defibrillators 2024-07-01
Whole Exome Sequencing and Whole Genome Sequencing 2025-07-26 updated 10-01
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