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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · OH · General Surgery, Plastic Surgery, Wound CareMedium impact

[Ohio] 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, three specific surgical procedure codes (Q4369, 30970T, and 0971T) will require prior authorization through Carelon Medical Benefits Management for Ohio Medicare Advantage members. Providers must submit prior auth requests via the Carelon provider portal, Availity Essentials, or email before performing these procedures to avoid claim denials.

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What to do

by Apr 30, 2026 · 4 steps
01Billing team and providers must implement prior authorization requirements for CPT codes 30970T and 0971T (breast tumor destruction procedures) and HCPCS code Q4369 (amnioplast wound repair).
02Update billing software to flag these codes for Ohio Medicare Advantage claims and require prior auth submission before service delivery.
03Establish workflow to submit authorization requests via Carelon's provider portal at providerportal.com (preferred method for real-time processing), or through Availity Essentials at Availity.com.
04Train front desk and clinical staff to communicate new authorization requirements to patients and providers.
If missed: Failure to obtain prior authorization will result in claim denials.

Codes mentioned

Q4369

Original notice

[Ohio] 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[Virginia] 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 policiesOH policy changesGeneral SurgeryPlastic SurgeryWound CareCode Q4369

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