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Special Alert January 2026 - Carelon Radiotracer Management for PET Imaging
Providence Health Plan·Nuclear Medicine, Radiation Oncology, Oncology +1 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jan 1, 2026
Summary
Effective April 1, 2026, Carelon will require submission of both PET CPT codes and radiotracer CPT codes together during the authorization process for Brain and Oncologic PET imaging procedures. Approved authorizations will specify which radiotracer categories are allowed based on clinical indication. This change affects the intake and prior authorization workflow for PET imaging claims.
Action Required
By March 15, 2026: Billing team must update authorization request procedures to require BOTH PET CPT codes AND radiotracer CPT codes to be submitted simultaneously when requesting Carelon authorization for Brain PET and Oncologic PET procedures. Update intake forms, EMR templates, and billing system workflows to enforce dual-code submission. Train providers and billing staff on the new requirement. Verify that authorization responses specify the approved radiotracer category. Cardiac PET procedures remain unchanged and should not include radiotracer codes. Failure to submit both codes together will delay or prevent authorization approval. Contact Carelon MBM at (800)-252-2021 with questions. This applies only to Providence Health Plan members.