MedicaidPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Cardiology, Cardiothoracic Surgery·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
May 27, 2026
Summary
Effective July 1, 2026, four new cardiovascular CPT codes (C7568, C7569, C7570, C7571) for advanced coronary procedures now require precertification/prior authorization through Carelon Medical Benefits Management for Virginia Medicaid. Billing teams must implement these codes into their prior authorization workflows immediately.
Action Required
By June 30, 2026: Billing team must update billing system and prior authorization workflows to require precertification for CPT codes C7568, C7569, C7570, and C7571 for all Virginia Medicaid claims with service dates on or after July 1, 2026. Update encounter forms and provider templates to alert cardiology and interventional cardiology providers to obtain prior authorization before these procedures. Instruct providers and billing staff to submit authorization requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). Claims submitted without required prior authorization will be denied. Contact Carelon Medical Benefits Management at MedicalBenefitsManagement.guidelines@Carelon.com for policy clarification.