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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · VA · Plastic Surgery, General Surgery, DermatologyMedium impact

[Virginia] Carelon Medical Benefits Management, Inc. code updates

Act
by Apr 30, 2026
Effective date
May 1, 2026
Identified
May 18, 2026

Summary

Effective May 1, 2026, Carelon Medical Benefits Management is adding three surgical procedure codes (Q4369, 30970T, 0971T) to its prior authorization requirements for Medicare Advantage plans in Virginia. Billing teams must implement prior authorization verification for these codes before the effective date to prevent claim denials.

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What to do

by Apr 30, 2026 · 5 steps
01Billing team must update the billing system to require prior authorization for CPT codes 30970T and 0971T (breast tumor destruction procedures) and HCPCS code Q4369 (wound repair with Amnioplast) for all Medicare Advantage patients under Carelon Medical Benefits Management in Virginia.
02Update encounter forms and clinical templates to alert providers that these procedures require prior auth.
03Configure the system to block claims submission without documented prior authorization approval.
04Submit all prior authorization requests through Carelon's provider portal (providerportal.com) or via Availity Essentials.
05Claims submitted without required prior authorization will be denied.

Codes mentioned

Q4369

Original notice

[Virginia] Carelon Medical Benefits Management, Inc. code updates
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[New York] Carelon Medical Benefits Management, Inc. code updatesMediumEffective May 1, 2026 · Provider Bulletin[California] Carelon Medical Benefits Management, Inc. code updatesMediumEffective May 1, 2026 · Provider Bulletin[Ohio] Carelon Medical Benefits Management, Inc. code updatesMediumEffective May 1, 2026 · Provider Bulletin[Georgia] Carelon Medical Benefits Management, Inc. code updatesMediumEffective May 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesVA policy changesPlastic SurgeryGeneral SurgeryDermatologyCode Q4369

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