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

[New York] Carelon Medical Benefits Management, Inc. code updates

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

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What to do

by Apr 30, 2026 · 5 steps
01Billing 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).
02Update billing system workflow to automatically flag these codes for Medicare Advantage patients in New York and route to prior authorization staff.
03Train providers to submit authorization requests through Carelon's provider portal (providerportal.com) or Availity Essentials before scheduling or performing these procedures.
04Maintain copies of approval documentation with claims.
05Claims submitted without required prior authorization will be denied.

Codes mentioned

Q4369

Original notice

[New York] 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 →
[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[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 policiesNY policy changesGeneral SurgeryPlastic SurgeryWound CareCode Q4369

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