Carelon Medical Benefits Management recognizes the key role that you and other medical practices play in the delivery of care for patients with musculoskeletal conditions and chronic pain. Developed in collaboration with your patients’ health plans, our Musculoskeletal Program helps support quality care that is consistent with evidence-based medicine. And that’s good news for your practice and the patients you serve.

Our process
Carelon is here to assist in your efforts to deliver the best quality and affordable care for your patients. The clinical information you submit is reviewed against Carelon clinical guidelines and health plan specific medical policies to ensure alignment with current best practices. Providers benefit by having a central location to obtain authorizations required by your patients’ health plans.

Our program reviews inpatient and outpatient non-emergency treatment or procedures.

Note: Review requirements and modalities may vary by health plan. Please verify or check with the patient’s health plan if you have any questions.

Treatments and procedures within the scope of this program include but are not limited to:

Spine surgery – Cervical, thoracic, lumbar, sacral and sacroiliac joint fusion

• Bone grafts
• Bone growth stimulators
• Cervical/lumbar foraminotomies
• Cervical/lumbar spinal fusions
• Cervical/lumbar spinal laminectomy
• Cervical/lumbar spinal discectomy
• Cervical/lumbar spinal disc arthroplasty (replacement)
• Spinal deformity (scoliosis/kyphosis)
• Vertebroplasty/kyphoplasty

Joint surgery

• Hip arthroplasty
• Knee arthroplasty
• Shoulder arthroplasty
• Hip arthroscopy
• Knee arthroscopy
• Shoulder arthroscopy
• Treatment of osteochondral defects
• Meniscal allograft transplantation
• Small joint surgery
  • Total ankle replacement
  • Hammertoe correction
  • Bunionectomy
  • Hallus rigidus
  • 1st toe arthrodesis

Interventional pain management

• Epidural steroid injections
• Paravertebral facet joint injection/Nerve block/Neurolysis
• Sacroiliac steroid injections
• Spinal cord stimulators
• Regional sympathetic nerve block