Commercial Medical Policy Notification Effective January 1, 2026 Posted December 16, 2025

Effective January 1, 2026, Blue Cross NC will archive select commercial medical policies. Beginning on this date, Carelon Medical Benefits Management will administer utilization management for these services using their own clinical guidelines. These guidelines can be accessed at Carelon Clinical Guidelines and Pathways⁠.

The affected Blue Cross NC commercial medical policies include:

• Artificial Intervertebral Disc
• Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
• Autologous Chondrocyte Transplantation
• Cervical Spine Procedures
• Diagnosis and Treatment of Sacroiliac Joint Pain
• Facet Joint Denervation
• Lumbar Spine Procedures
• Percutaneous Intradiscal and Intraosseous Radiofrequency Procedures of the Spine
• Sacroiliac Joint Fusion/Stabilization
• Spinal Cord Stimulation
• Vertebroplasty, Kyphoplasty, and Sacroplasty (Percutaneous)

Note: The policies being archived will be addressed under Carelon’s musculoskeletal guidelines.

Carelon currently manages medical benefits for Blue Cross NC’s commercial membership in the following areas:

• Diagnostic imaging
• Cardiology
• Musculoskeletal procedures
• Sleep solutions
• Oncology medication
• Rehabilitation therapies