Carelon Clinical Appropriateness Guidelines for Joint Surgery, Spine Surgery, and Pain Management
Joint Surgery
OPEN THE GUIDELINES FOR JOINT SURGERY EFFECTIVE SEPTEMBER 11, 2022
Spine Surgery
OPEN THE GUIDELINES FOR SPINE SURGERY EFFECTIVE SEPTEMBER 11, 2022
Interventional Pain Management
OPEN THE GUIDELINES FOR INTERVENTIONAL PAIN MANAGEMENT EFFECTIVE MARCH 13, 2022
COMING SOON INTERVENTIONAL PAIN MANAGEMENT GUIDELINES EFFECTIVE NOVEMBER 6, 2022
Level of Care for Musculoskeletal Surgery and Procedures
OPEN THE LEVEL OF CARE GUIDELINES FOR MUSCULOSKELETAL PROCEDURES EFFECTIVE JANUARY 1, 2022
CPT code lists
To access the current CPT code list, please refer to the appropriate BCBS health plan provider page
- Illinois Commercial
- Montana
- New Mexico Commercial
- Blue Cross Centennial CommunitySM (New Mexico Medicaid)
- Oklahoma (look for the link to “Preauthorization Requirements Lists”)
- Texas
Archived Guidelines
Please note archived guidelines effective March 14, 2021 replaced January 1, 2021 versions. Clinical content did not change.
INTERVENTIONAL PAIN MANAGEMENT
- Interventional Pain Management effective November 7, 2021 – March 12, 2022
- Interventional Pain Management effective March 14, 2021 – November 6, 2021
- Interventional Pain Management effective January 1 – March 13, 2021
JOINT SURGERY
- Joint Surgery effective September 12, 2021 – September 10, 2022
- Joint Surgery effective March 14, 2021 – September 11, 2021
- Joint Surgery effective January 1 – March 13, 2021
SPINE SURGERY
- Spine Surgery effective June 12, 2022 – September 10, 2022
- Spine Surgery effective January 1, 2022 – June 11, 2022
- Spine Surgery effective November 7, 2021 – December 31, 2021
- Spine Surgery effective September 12, 2021 – November 6, 2021
- Spine Surgery effective March 14, 2021 – September 11, 2021
- Spine Surgery effective January 1 – March 13, 2021
Level of Care for Musculoskeletal Surgery and Procedures
- Level of Care effective January 1, 2021 – December 31, 2021