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Anthem BCBSMedicaid · Prior Auth · Provider Bulletin · NY · Oncology, Genetics, NeurologyMedium impact

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Act
by Jul 31, 2026
Effective date
Aug 1, 2026
Identified
Jun 25, 2026

Summary

Effective August 1, 2026, CPT code 81345 (TERT gene analysis for thyroid carcinoma and glioblastoma multiforme) now requires precertification/prior authorization through Carelon Medical Benefits Management for New York Medicaid beneficiaries. Ordering and servicing providers must submit authorization requests via the Carelon provider portal, Availity Essentials, or email before performing this genetic test.

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What to do

by Jul 31, 2026 · 5 steps
01Billing team and ordering providers must implement prior authorization requirement for CPT 81345 in all systems and workflows.
02Update billing software to flag CPT 81345 as requiring Carelon Medical Benefits Management precertification before claim submission.
03Providers must obtain prior authorization through one of three methods: (1) Carelon provider portal at https://providerportal.com (24/7 access, recommended), (2) Availity Essentials at https://Availity.com, or (3) email to MedicalBenefitsManagement.guidelines@Carelon.com.
04Add CPT 81345 to encounter forms and pre-visit planning tools with a reminder to obtain authorization.
05Update front desk and clinical staff that this genetic test requires precertification.
If missed: Failure to obtain prior authorization will result in claim denials for New York Medicaid members effective August 1, 2026.

Codes mentioned

81345

Original notice

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

See all Anthem BCBS changes →
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider Bulletin[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Nov 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesNY policy changesOncologyGeneticsNeurologyCode 81345

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