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Changes to Carelon Clinical Practice Guidelines for Radiology Services
Blue Cross Blue Shield of Vermont·Radiology, Orthopedics, Cardiology +3 more·Provider News
Effective date
Sep 19, 2026
We identified it
Jun 19, 2026
Summary
Carelon updated clinical appropriateness guidelines for multiple radiology services effective September 19, 2026, including expanded criteria for brain CT perfusion, extremity imaging for osteomyelitis and meniscal tears, vascular imaging with new CTA/MRA allowances, and cardiac imaging updates. These changes affect prior authorization requirements and coverage determinations for imaging studies.
Action Required
Before September 19, 2026: Billing and authorization staff must update prior authorization protocols to reflect new Carelon clinical guidelines for radiology services. Review and update internal protocols for brain CT perfusion, extremity imaging (especially osteomyelitis and meniscal tears), vascular CTA/MRA studies, and cardiac imaging to align with expanded coverage criteria. Train staff on new duplex ultrasound requirements prior to CTA/MRA for stroke/TIA symptoms present more than 30 days. Failure to follow updated guidelines may result in imaging study denials.