Medicare AdvantagePrior AuthMedium impact
[New York] Carelon Medical Benefits Management, Inc. code updates
Anthem BCBS·NY · General Surgery, Plastic Surgery, Wound Care·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 20, 2026
Summary
Effective May 1, 2026, three surgical procedure codes (Q4369, 30970T, 0971T) will require prior authorization through Carelon Medical Benefits Management for Medicare Advantage plans in New York. Providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing these procedures.
Action Required
By April 30, 2026: Billing team and ordering providers must implement prior authorization requirements for CPT codes 30970T and 0971T (breast laser procedures) and HCPCS code Q4369 (wound repair with Amnioplast). Update billing system workflow to automatically flag these codes for Medicare Advantage patients in New York and route to prior authorization staff. Train providers to submit authorization requests through Carelon's provider portal (providerportal.com) or Availity Essentials before scheduling or performing these procedures. Maintain copies of approval documentation with claims. Claims submitted without required prior authorization will be denied.