CommercialPrior AuthMedium impact
[Virginia] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · OB-GYN, Genetics·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
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.
Action Required
By September 15, 2026: Billing team must update billing software to require prior authorization for CPT code 0253U for all Virginia Commercial and PPO plans. Add this code to the precertification requirement list in the system. Notify 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. Claims submitted without prior authorization will be denied. No claims for this procedure should be processed without documented prior auth approval.