CommercialPrior AuthMedium impact
[Virginia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·VA · Infectious Disease, Wound Care, General Surgery +1 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 1, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield (including HealthKeepers, Inc.) now requires prior authorization/precertification for CPT code 0600U (infectious disease wound infection genetic testing with organism and antibiotic resistance identification) for all Virginia PPO and HMO commercial plans. Providers must submit authorization requests through Carelon Medical Benefits Management before performing this test.
Action Required
By October 31, 2026: Billing and clinical staff must update internal workflows and billing system alerts to require prior authorization submission for CPT code 0600U before ordering or performing this genetic testing. Providers should submit precertification requests to Carelon Medical Benefits Management via their provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com). Update order entry forms and encounter templates to include a requirement for authorization documentation. Claims for CPT 0600U submitted without prior authorization will be denied by Anthem plans in Virginia effective November 1, 2026.