MedicaidPrior AuthMedium impact
[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·NY · Cardiology, Radiology, Cardiothoracic Surgery·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
May 27, 2026
Summary
Effective July 1, 2026, Carelon Medical Benefits Management requires prior authorization for four specific cardiovascular procedures (CPT codes C7568, C7569, C7570, C7571) for New York Medicaid and commercial plans. Ordering and servicing providers must submit precertification requests through Carelon's provider portal, Availity Essentials, or email before performing these coronary catheterization and angioplasty procedures.
Action Required
By June 30, 2026: Billing and clinical teams must implement prior authorization requirements for CPT codes C7568, C7569, C7570, and C7571 when performed for Carelon-covered Medicaid and commercial patients in New York. Update billing system and EMR templates to flag these codes as requiring precertification before claim submission. Providers must submit authorization requests through Carelon's provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com). Front desk and clinical staff should verify authorization status prior to procedure scheduling. Failure to obtain prior authorization will result in claim denials and potential patient financial responsibility.