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

[New York] Prior authorization requirement updates — Carelon Medical Benefits Management

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
May 27, 2026

Summary

Effective October 1, 2026, CPT code 0253U (reproductive medicine endometrial receptivity analysis) now requires prior authorization through Carelon Medical Benefits Management for commercial plans in New York. Billing teams must implement this requirement in their workflows and direct providers to submit authorization requests via the Carelon provider portal or Availity Essentials before services are rendered.

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What to do

by Sep 30, 2026 · 5 steps
01Billing team must update billing system and encounter forms to require prior authorization for CPT 0253U (endometrial receptivity analysis).
02Communicate to all ordering and servicing providers that this code now requires precertification through Carelon Medical Benefits Management before services are performed.
03Providers must submit authorization requests via the Carelon provider portal at https://providerportal.com or through Availity Essentials at https://Availity.com.
04For guideline questions, contact MedicalBenefitsManagement.guidelines@Carelon.com.
05Claims submitted without prior authorization will be subject to denial by Carelon.

Original notice

[New York] Prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
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Related changes

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[New York] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Virginia] 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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