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

[California] 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 will require prior authorization for three breast and wound care procedures: Q4369 (Amnioplast wound repair), 30970T (benign breast tumor laser destruction), and 0971T (malignant breast tumor laser destruction) for Medicare Advantage members in California. Providers must submit prior auth requests through Carelon's provider portal, Availity Essentials, or email before performing these procedures.

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What to do

by Apr 30, 2026 · 4 steps
01Billing team must update prior authorization requirements in billing system to flag CPT codes 30970T and 0971T and HCPCS code Q4369 as requiring prior authorization through Carelon Medical Benefits Management for all California Medicare Advantage claims.
02Providers and front desk staff must be notified to submit prior authorization requests before scheduling or performing these procedures using Carelon's provider portal (providerportal.com) or Availity Essentials.
03Failure to obtain prior authorization will result in claim denials.
04Update encounter forms and provider guidelines accordingly.

Codes mentioned

Q4369

Original notice

[California] 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[Ohio] 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 policiesCA policy changesGeneral SurgeryPlastic SurgeryWound CareCode Q4369

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