CommercialPrior AuthMedium impact
[Georgia] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · OB-GYN, Genetics·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
May 27, 2026
Summary
Effective October 1, 2026, CPT code 0253U (reproductive medicine endometrial receptivity analysis) will require prior authorization/precertification through Carelon Medical Benefits Management for commercial plans in Georgia. Billing teams must implement this requirement in their authorization workflows and direct providers to submit requests through the Carelon provider portal or Availity.
Action Required
By September 15, 2026: Billing team must update authorization protocols to require prior authorization for CPT code 0253U for all Georgia commercial plan members. Configure billing system to flag claims for this code and route to authorization queue before submission. Notify ordering and servicing providers that precertification requests must be submitted to Carelon Medical Benefits Management via: (1) Carelon provider portal at https://providerportal.com (24/7 online access, fastest method), or (2) Availity Essentials at https://Availity.com. Claims submitted without prior authorization will be denied. Direct provider questions about authorization guidelines to MedicalBenefitsManagement.guidelines@Carelon.com. Reference UM AROW #A2026M5374 when requesting authorization.