CommercialCoverageHigh impact
Medical Policy and Coding Updates - March 2024
Premera Blue Cross·WA, AK · Oncology, OB-GYN, Radiology +4 more·Medical Policy
Effective date
Jun 30, 2024
We identified it
Jun 18, 2026
Summary
Carelon Medical Benefits Management (formerly AIM) updated clinical appropriateness guidelines for genetic testing, radiation therapy, advanced imaging, and oncologic services with multiple effective dates from April to June 2024. These updates expand coverage for certain genetic tests, modify radiation therapy criteria, and add new imaging indications while clarifying what services are not medically necessary.
Action Required
By June 30, 2024: Billing teams must review and update prior authorization processes for genetic testing services to align with new Carelon guidelines. Update documentation requirements for carrier screening to include standard hemoglobinopathy screening for all pregnant individuals. By April 14, 2024: Verify radiation therapy dosing criteria for prostate cancer treatments and update imaging authorization workflows for cardiac CT, abdominal imaging, and oncologic screening procedures. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for specific guideline questions and download updated guidelines from their portal.