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Medical Policy and Coding Updates - June 2026
Premera Blue Cross·WA · Radiology, Diagnostic Imaging, Nuclear Medicine +4 more·Medical Policy
Effective date
Sep 19, 2026
We identified it
Jun 16, 2026
Summary
Multiple Carelon Medical Benefits Management clinical guidelines are being updated effective September 19, 2026, affecting radiology imaging criteria, sleep disorder management, and genetic testing requirements. Key changes include expanded imaging allowances for extremities and spine conditions, updated sleep study criteria, and revised genetic testing limitations.
Action Required
Before September 19, 2026: Billing and prior authorization teams must review and update all Carelon Medical Benefits Management guidelines for radiology imaging, sleep studies, and genetic testing. Download current guidelines from Carelon website and update internal authorization checklists. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for specific guideline questions. Update EMR templates to reflect new criteria for imaging requirements, sleep study indications, and genetic testing limitations to prevent claim denials.