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

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