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Anthem BCBSCommercial · Prior Auth · Provider Bulletin · VA · OB-GYN, GeneticsMedium impact

[Virginia] Prior authorization requirement updates — Carelon Medical Benefits Management

Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
May 27, 2026

Summary

Effective October 1, 2026, CPT code 0253U (endometrial receptivity analysis for reproductive medicine) will require prior authorization through Carelon Medical Benefits Management for all Commercial and PPO plans in Virginia. Billing teams must update systems to mandate precertification requests before these genetic testing procedures are performed or billed.

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What to do

by Sep 15, 2026 · 5 steps
01Billing team must update billing software to require prior authorization for CPT code 0253U for all Virginia Commercial and PPO plans.
02Add this code to the precertification requirement list in the system.
03Notify all ordering providers and reproductive medicine/genetics staff that prior auth must be obtained through Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) before the service is provided.
04Claims submitted without prior authorization will be denied.
05No claims for this procedure should be processed without documented prior auth approval.

Original notice

[Virginia] Prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[Virginia] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[New York] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Oct 1, 2026 · Provider Bulletin[Georgia] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Oct 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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