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[Georgia] Carelon Medical Benefits Management, Inc. code updates
Effective date
May 1, 2026
Identified
May 18, 2026
Summary
Effective May 1, 2026, Carelon Medical Benefits Management will require prior authorization for three specific surgical codes (Q4369, 30970T, 0971T) related to wound repair and breast tumor destruction procedures for Georgia Medicare Advantage members. Billing teams must implement prior authorization requirements in their systems and provider workflows before the effective date.
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What to do
Action · 3 steps
01Before May 1, 2026: Billing team must update prior authorization requirements in the billing system to flag CPT codes 30970T and 0971T, and HCPCS code Q4369 for Georgia Medicare Advantage plans.
02Providers must obtain prior authorization from Carelon Medical Benefits Management via their provider portal (providerportal.com), Availity Essentials, or direct contact before performing these procedures.
03Update encounter forms and superbills to alert providers that these codes now require prior auth.
If missed: Failure to obtain prior authorization will result in claim denials for Georgia Carelon Medicare Advantage members.
Codes mentioned
Q4369
Original notice
[Georgia] Carelon Medical Benefits Management, Inc. code updates
providernews.anthem.com · Always check the source before changing claims.
Related changes
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