CommercialPrior AuthMedium impact
[Ohio] Prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Radiation Oncology·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
May 27, 2026
Summary
Effective October 1, 2026, Carelon Medical Benefits Management is adding four radiation oncology CPT codes (77436, 77437, 77438, 77439) to their prior authorization requirement list for commercial plans in Ohio. Billing teams must begin obtaining precertification for these surface radiation therapy procedures through Carelon's provider portal or Availity before claims are submitted.
Action Required
By September 15, 2026: Billing team and radiation oncology providers must update internal workflows to require prior authorization for CPT codes 77436, 77437, 77438, and 77439 before claim submission. Update billing software rules and encounter forms to trigger prior auth requests for these codes. Submit all precertification requests via Carelon's provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) for dates of service on or after October 1, 2026. Failure to obtain prior authorization will result in claim denials for these radiation therapy procedures.