The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Carelon Clinical Appropriateness Guidelines for Musculoskeletal are developed through a rigorous process integrating evidence-based literature with expert physician review. Guidelines for joint surgery, spine surgery, and interventional pain management are included below.

The guidelines do not address coverage, benefit or other plan specific issues. Applicable federal and state coverage mandates take precedence over these clinical guidelines. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon guidelines.