Medicare AdvantagePrior AuthHigh impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Cardiology, Radiation Oncology·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 1, 2026
Summary
Effective November 1, 2026, Carelon Medical Benefits Management is adding new prior authorization requirements for specific cardiology catheterization procedures (CPT codes C7517, C7552, C7553) and one radiation oncology code (S8030) for Anthem Blue Cross and Blue Shield Medicare Advantage FIDE plans in Virginia. Billing teams must implement prior authorization checks for these codes before the effective date to avoid claim denials.
Action Required
By October 31, 2026: Billing team must update billing system to require prior authorization through Carelon Medical Benefits Management for CPT codes C7517, C7552, C7553 (cardiology catheterization procedures) and HCPCS code S8030 (radiation oncology). Update all encounter forms and provider templates to flag these codes for pre-service authorization. Configure system to route authorization requests to Carelon via their provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). Notify all cardiology and radiation oncology providers of new requirements. Claims submitted without prior authorization will be denied. This applies only to Anthem Medicare Advantage FIDE plans in Virginia.