Copies of the Carelon Clinical Appropriateness Guidelines are also available upon oral or written request. Carelon reviews all of its Guidelines at least annually.Ĭarelon makes its Guidelines publicly available on its website twenty-four hours a day, seven days a week. Relevant citations are included in the References section attached to each Guideline. The Carelon guideline development process complies with applicable accreditation standards, including the requirement that the Guidelines be developed with involvement from appropriate providers with current clinical expertise relevant to the Guidelines under review and be based on the most up-to-date clinical principles and best practices. To promote the most efficient and cost-effective use of services To curtail the performance of inappropriate and/or duplicate services

To encourage standardization of medical practice patterns To assist the practitioner as an educational tool To establish criteria for when services are medically necessary (i.e., in general, shown to be effective in improving health outcomes and considered the most appropriate level of service) In the process, multiple functions are accomplished:

As used by Carelon, the Guidelines establish objective and evidence-based criteria for medical necessity determinations where possible. The Carelon Clinical Appropriateness Guidelines (hereinafter “the Carelon Clinical Appropriateness Guidelines” or the “Guidelines”) are designed to assist providers in making the most appropriate treatment decision for a specific clinical condition for an individual. History Description and Application of the Guidelines Simultaneous Ordering of Multiple Diagnostic or Therapeutic Interventions All rights reserved.ĭescription and Application of the Guidelines © 2023 Carelon Medical Benefits Management, Inc. Please consult the applicable health plan for more details.Īppropriate Use Criteria: Imaging of the Spine Smooth and continuous and that C2 does not appear 'fat' (i.e.Approval and implementation dates for specific health plans may vary.

Make sure the basion-dens space is < 12 mm.

Make sure the atlantodens interval (ADI or pre-dental space) is < 3 mm in adults or < 5 mm in.

Check that the intervertebral spaces are uniform at each level.

Surface of the occipital and sphenoid bones)

Clivus should be pointing toward the odontoid (the clivus lies at the base of the skull is made from the.

Inspect each vertebral body, pedicle, lamina and spinous process from C1 - C7

Check the posterior vertebral line (posterior longitudinal ligament line).

Check the anterior vertebral line (anterior longitudinal ligament line).

Evaluate the orientation of the epiglottis, hyoid bone, tracheal shadow and check for any foreign bodies.

Vertebral body) and < 22 mm in front of C6 (or no more than width of C6 Tissue is < 7 mm in thickness in front of C2 (or < 50% of the width of C2

Make sure you can see all 7 cervical spinous process.

The clinician should establish a process or order they follow each time. To the tip of the dens (or odontoid process). The dorsal surface of the clivus and is used to measure the distance of space This is a line drawn from the caudal extension of The tip of the dens should lie less than 4.5 cm above this line. Draw a line from the posterior edge of the hard palate to the caudal end of the occipital curve. Opisthion (posterior aspect of the foramen magnum) cannot be identified on a To recognize the presence of basilar invagination (a craniocervical junctionĪbnormality where the tip of the dens project up into the foramen magnum).

If the tip of the dens extends > 3 mm above this line then it helps.

The odontoid tip extends above this line. Posterior surface of the hard palate to the tip of the opisthion (posteriorĪspect of the foramen magnum) and is used to measure the distance of how much (normal CT values for men is > 23.7 mm and for women is > 24.2 mm) can be used instead. Tip of the dens is eroded then the Redlund-Johnell and modified Ranawat methods The dens (or odontoid process) should be ~5 mm below this line. Lateral radiograph of the skull or on a sagittal cut from a CT or MRI scan thatĬonnects the posterior and anterior aspects of the foramen magnum. Note: Scroll over or tap on the image to see labels & lines

Healthy cervical spine x ray