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Anthem BCBSMedicaid · Prior Auth · Provider Bulletin · NY · Cardiology, Oncology, Hematology +9 moreMedium impact

[New York] Carelon Medical Benefits Management code updates

Effective date
Oct 1, 2026
Identified
Jun 25, 2026

Summary

Effective October 1, 2026, Carelon Medical Benefits Management requires prior authorization for New York Medicaid dates of service on and after that date for a list of CPT codes in its cardiology, genetics and MSK programs. The cardiology codes 0913T and 0914T cover intracoronary drug-delivery balloon procedures, and the genetics codes cover genetic and genomic tests such as oncology, cardiology, rare disease, obstetric and pharmacogenomic tests. The MSK code 0707T covers injection of bone substitute material into a subchondral bone defect, including imaging guidance and arthroscopic assistance.

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What to do

Action · 4 steps
01Already effective October 1, 2026: Obtain prior authorization from Carelon Medical Benefits Management for the listed CPT codes on dates of service on and after October 1, 2026.
02Ordering and servicing providers may submit requests online at https://www.providerportal.com, which is available 24/7 and is the fastest way to request authorization, or through Availity Essentials at https://www.availity.com/.
03For questions about the guidelines, contact Carelon Medical Benefits Management at MedicalBenefitsManagement.guidelines@Carelon.com.
04Current and upcoming guidelines can be downloaded from the link in the notice.

Codes mentioned

8119581558

Original notice

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

See all Anthem BCBS changes →
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Oct 1, 2026 · Provider Bulletin[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Jul 1, 2026 · Provider Bulletin[New York] Carelon Medical Benefits Management, Inc. code updatesMediumEffective May 1, 2026 · Provider Bulletin[New York] Carelon Medical Benefits Management, Inc. Code UpdateMediumEffective Apr 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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