Radiation Oncology: Services Reviewed by Carelon Medical Benefits Management
Administrative guideline listing outpatient radiation oncology services that require clinical review by Carelon Medical Benefits Management for Premera members; intended for providers submitting requests via the Carelon provider portal.
Removed reference to prior authorization within the Introduction section and replaced with the term clinical review.
Added Oligometastatic extracranial disease and skin cancer to the list of radiation oncology services reviewed by Carelon.
Clarified names of disorders under broad clinical indication category names for clarity.
Services Requiring Clinical Review
Services Reviewed
The following outpatient radiation oncology services are reviewed by Carelon Medical Benefits Management:
Clinical review requests must be submitted via the Carelon Provider Portal as indicated in the Administrative Guideline.
This medical policy does not apply to Medicare Advantage members.
Submission & Review Requirements for Providers
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